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A case of a Descemet's membrane detachment (DMD) caused by the inadvertent intracorneal injection of sodium hyaluronate was presented. This was concluded after chemical analysis of a viscous substance found in a patient's cornea showed to be a breakdown product of sodium hyaluronate. Surgical correction of the detachment included removing the viscous substance and tamponading the detachment with an air bubble. Although other gases such as sulfur hexafluoride (SF6) provide longer means of tamponade, they have increased postoperative risks like glaucoma associated with their use. Air can provide an effective means of tamponade with minimal postoperative risks.

Purpose: To report a case where combined whole-body Fluorine-18 fluorodeoxyglucose (FDG) PET-CT scanning was used to aid in the diagnosis of a patient with occult sarcoidosis. Design: Case report. Methods: FDG PET-CT scanning was performed in a patient who presented with persistent bilateral panuveitis after cataract surgery and had undergone an extensive negative workup. Results: FDG PET-CT scanning demonstrated extensive mediastinal adenopathy. Biopsy showed a non-caseating granuloma with associated giant cell formation consistent with a diagnosis of sarcoidosis. Conclusions: FDG PET-CT scanning generates tomographic scans with excellent sensitivity, spatial resolution, and anatomical landmark identification and may be useful in the workup of idiopathic uveitis.

Aim: To describe the complications related to cataract surgery performed by phacoemulsification technique by third-year ophthalmology residents at New Jersey Medical School, who are trained to perform phacoemulsification without any prior experience with extracapsular extraction. Design: Retrospective, observational case series. Methods: A retrospective chart review of 755 patients who underwent cataract surgery by third-year residents between July 2000 and June 2005 at the Institute of Ophthalmology and Visual Science was performed. Details of intraoperative complications (posterior capsular rupture, vitreous loss, subluxation of lens fragments into the vitreous, extracapsular cases converted to phacoemulsification, retinal detachment, vitreous haemorrhage and haemorrhagic choroidals) of the cases done by phacoemulsification technique were recorded. Results were analysed and compared with complication rates reported from other residency programmes and from experienced ophthalmologists. Results: Of 755 cataract surgeries, 719 were performed using phacoemulsification technique. Posterior capsule disruption occurred in 48 (6.7%), vitreous loss in 39 (5.4%) and dislocated lenticular fragments in 7 (1.0%) of 719 cases that underwent phacoemulsification technique. Subsequent pars plana lensectomy was required in 5 (0.7%) cases; 1 case (0.1%) experienced retinal detachment and haemorrhagic choroidal detachment. Conclusion: The residents can perform phacoemulsification well with a very low complication rate, without prior training with extracapsular cataract extraction technique.

Although the exact mechanisms that lead to uveitis are not entirely known, the role of cytokines in the pathogenesis of this disease has been shown to be important. Prior studies described the presence of an array of cytokines in the intraocular fluid of patients with uveitis. Review of these studies indicate that Interleukin-6 (IL-6) is present, and animal data suggest the important role of IL-6 in the regulation of ophthalmologic immune responses.We investigated whether IL-6, TNF-alpha, IL-1 alpha, beta, IL-2 are present in the vitreous of patients with active intermediate and posterior uveitis.Vitreous specimens were collected from 23 eyes of patients with active intermediate and posterior uveitis who underwent diagnostic or therapeutic vitrectomies. TNF-alpha, IL-1 alpha and beta, IL-2 and IL-6 were measured by enzyme-linked immunosorbent assay. Eight vitreous fluid samples from eye bank eyes were used as control.IL-6 was higher in the vitreous of patients with uveitis compared to control samples (p = 0.0119). No TNF-alpha, IL-2, IL1-alpha or beta was detected. The levels of IL-6 did not correlate with a specific clinical diagnosis, but patients with pars planitis and panuveitis had the highest levels (p = 0.58)IL-6 is elevated in the vitreous of patients with active intermediate and posterior uveitis.

Vasculitic disorders are relatively rare. Their etiology and pathophysiology remain enigmatic, leading to confusing nomenclature and multiple classification schemes. Untreated vasculitis can be fatal. Early diagnosis is the key to successful treatment and better prognosis. However, early diagnosis can be difficult; vasculitic conditions usually present with non-specific symptoms for a long period before clinically overt manifestations occur. Ophthalmologists should be familiar with the ocular manifestations of the vasculitic disorders because they may not only be sight-threatening, but more importantly could be the presenting manifestations of active, potentially lethal systemic disease. This review summarizes clinical and ocular manifestations of systemic vasculitic disorders. Furthermore, it discusses general concepts in diagnosis and treatment of these diseases in an effort to provide a practical framework for the ophthalmologist evaluating patients with vasculitis.

Objective: To evaluate the efficacy of etanercept vs placebo in preventing relapses of uveitis in patients taking methotrexate with control of uveitis and whose methotrexate dosage was being tapered. Methods: Patients with chronic or recur-rent noninfectious uveitis with inflammation controlled by low-dose methotrexate were randomized to either the drug or placebo group in a double-masked manner, given a methotrexate taper schedule, and followed for 24 weeks. The main outcome measures were control of inflammation, visual acuity, and adverse reactions. Data were analyzed both as an attempt-to-treat analysis and an analysis only of those patients who completed the study. Results: A total of 20 patients were randomized to the drug and placebo groups. Relapse of uveitis occurred in 3 of 10 patients in the treatment group and 5 of 10 patients in the control group. Two patients in the treatment group withdrew prematurely from the study due to adverse effects. There was no significant difference between the treatment and placebo groups with regard to the rate of relapse and the final visual acuity. No patient suffered from any irreversible, long-term morbidity or mortality. Conclusion: Etanercept has no significant efficacy over placebo in preventing relapses of uveitis in patients being tapered from methotrexate. Arch Ophthalmol, 2003;121:437-440.

Purpose To evaluate the efficacy and safety of daclizumab therapy for patients with various ophthalmologic inflammatory disorders (all having previously failed standard treatment methods). Design Retrospective, nonrandomized case series. Participants Fourteen patients. Methods Fourteen patients were treated with daclizumab after previously failing standard treatment methods. Main outcome measures Inflammation and visual acuity. Results Twelve of 27 (44%) eyes and 5 of 14 (36%) patients had improvement in visual acuity; 9 of 27 (33%) eyes and 5 of 14 (36%) patients had no change in visual acuity; and 6 of 27 (22%) eyes and 4 of 14 (27%) patients had continued visual loss. Based on degree of inflammation, 16 of 27 eyes (59%) had improvement, 3 of 27 (11%) eyes had no change, and 8 of 27 (30%) eyes worsened. Conclusions Daclizumab is safe and, at least in some patients, appears to be an effective medication in the treatment of ocular inflammatory disorders.

PURPOSE To report a case in which corneal autograft and allograft were performed in a 10.5-month-old, ex 24-week, premature boy with bilateral corneal opacities from infectious keratitis. METHODS Case report based upon chart review. RESULTS At 3 years, the corneal autograft is clear without vascular ingrowth. After transplantation, the clarity of the autograft improved markedly and unexpectedly from its pretransplantation appearance. The child fixes and follows and has central steady maintained fixation at near with a spectacle correction of +11.00 diopters. The allografted cornea is opaque with 360 degrees of vascular ingrowth. This eye is phthisical with no response to light. CONCLUSIONS In circumstances in which a viable cornea is available from the patient's worse prognosis eye, a corneal autograft is a potential treatment option.

Purpose To describe an unusual and possibly new keratopathy in human immunodeficiency virus (HIV)-positive patients. Design Retrospective observational case series. Participants: Six HIV-positive patients at four centers. Methods A complete medical history was obtained and a thorough ophthalmic examination was performed on each of the patients. Results Each patient had bilaterally symmetrical keratopathy consisting of variably pigmented round and reticular posterior intracorneal precipitates at the level of Descemet’s membrane. The precipitates were diffuse, but larger and more prominent near the limbus and finer toward the central cornea. None of the eyes were inflamed, and all had normal vision. No patient had uveitis on presentation or any history of cytomegalovirus retinitis. Conclusion These patients have a unique posterior keratopathy, which requires further investigation.

HEALTH CARE COSTS AND UTILIZATION FOR PRIVATELY INSURED PATIENTS TREATED FOR NON-INFECTIOUS UVEITIS IN THE UNITED STATES Johnson S1, Duh MS1, Mallya U2, Diener M3, Sorg R3, Chu D4 1Analysis Group, Inc., Boston, MA, USA, 2Novartis Pharmaceuticals Corporation, Florham Park , NJ, USA, 3Analysis Group, Inc., New York, NY, USA, 4UMDNJ, Newark, NJ, USA OBJECTIVES: Describe costs and utilization patterns of corticosteroid (CTS), immunosuppressive (IMS), and biologic (BIO) treatment use in patients with chronic non-infectious uveitis. Costs and utilization of CTS, IMS and BIO indicate economic burden but have not been studied in a large sample. METHODS: Patients with 31 NPSU diagnosis (ICD-9-CM 360.x–364.x, excluding infectious uveitis) by an ophthalmologist or 32 by a primary care physician, under age 65, with continuous insurance coverage during a six-month baseline were selected from a privately insured claims database (N 80.7 million). Sample index dates were defined as the first prescription/administration of CTS, IMS, or BIO between 2003-2009. CTS patients had 32 10-day or 31 30-day scripts. Analysis was in a per-member-per-month (PMPM) framework based on treatment episodes, defined as continuous medication use within the same class. Wilcoxon rank-sum and chi-square tests were used for comparisons of costs and categorical outcomes. RESULTS: CTS (N 19,426), IMS (N 5,466) and BIO (N 1,694) samples were selected; average time on continuous therapy (i.e., treatment episode duration) was 1.79, 3.66, and 8.18 months (p 0.05 across groups). Baseline Charlson Comorbidity Index was highest for BIO (0.83), then IMS (0.78), then CTS (0.039) (p 0.05 across groups). Baseline PMPM inpatient admission rates were 0.021 for CTS, 0.044 for IMS, and 0.045 for BIO (p 0.05 across groups); study period values were 0.032, 0.048, and 0.024, respectively (p 0.05 CTS different vs. both). Emergency room visits had a similar ordering. Baseline average PMPM costs for CTS were $717; IMS were $1738; and BIO were $1439 (p 0.05 across groups). Study period PMPM costs excluding drug or biologic costs were $974 for CTS; were $1592 for IMS; and were $918 for BIO (p 0.05 across groups). CONCLUSIONS: BIO had the best relative change in outcomes, followed by IMS. There could be underuse of these products relative to CTS.

Purpose To determine the effectiveness and steroid-sparing capabilities of methotrexate in the treatment of chronic, noninfectious, nonnecrotizing scleritis. Design Retrospective chart review. Methods We conducted a retrospective chart review of all patients treated for scleritis between January 1, 2000 and July 31, 2005 at the Institute of Ophthalmology and Visual Science at New Jersey Medical School of the University of Medicine and Dentistry of New Jersey. Outcome measures included inflammation, corticosteroid and methotrexate dosages, visual acuity, and reported side effects. Results Eighteen patients, with a total of 27 affected eyes, were included in the study: 15 women and three men with a mean age of 52 years. Inflammation control was achieved in 11 patients, nine women and two men. Successful corticosteroid sparing was achieved in 10 of the 11 patients, with three patients completely discontinuing corticosteroid use. Visual acuity was maintained or improved in 21 (78%) of 27 affected eyes. Eight patients reported adverse effects, with one patient discontinuing treatment because of unbearable fatigue. The dose of methotrexate ranged from 7.5 to 35 mg weekly. The mean duration of methotrexate therapy was 19 months (standard deviation, 11 months). There were no serious adverse reactions or long-term morbidity caused by methotrexate therapy. Conclusions Methotrexate seems to be a well-tolerated therapy that can reduce inflammation successfully and can decrease the corticosteroid requirement in the treatment of chronic, noninfectious, and nonnecrotizing scleritis.

1. 1. A method of relating oxygen consumption in Mercenaria mercenaria to pumping rates at 25°C and 22% is described. 2. 2. For specimens of Mercenaria from 5 to 285 g, the relationship between oxygen consumption and total wet weight was predicted by the regression equation: log Q O 2 = −0·344 log weight −1·023. 3. 3. The regression equation predicting the relationship between pumping rate and weight was: log pumping rate = 0·656 log weight−0·569. 4. 4. The efficiency of withdrawal of oxygen was constant for animals of all weights; this value was statistically 2·91 l. of water pumped for each 1·0 ml of oxygen removed.

1. The effect of whole tetanus toxin (TeTX) and of its light chain (TeTX L-chain) on transmitter release was determined by presynaptic pressure-injection in the squid giant synapse. 2. The results indicate that whole TeTX does not modify transmission while the L-chain blocks transmission within 20-30 min. This block does not involve changes in the sodium or potassium conductances responsible for spike generation or the voltage-dependent presynaptic calcium current responsible for transmitter release. 3. Western blotting of protein fractions from the squid optic lobe demonstrated the presence of a protein which reacted with specific antibodies against mammalian synaptobrevin, a vesicular protein. In addition, this protein was enzymatically cleaved by the L-chain component of the toxin in a similar fashion to its mammalian counterpart. 4. These results demonstrate that TeTX L-chain toxin acts directly on a squid synaptobrevin and prevents synaptic release probably by interfering with the docking-fusion synaptic vesicles at the active zone.

Background The purpose of this study was to describe comorbidities, healthcare costs, and resource utilization among patients with chronic non-infectious uveitis initiating corticosteroid, immunosuppressants, or biologics. In this retrospective cohort study, patients with a non-infectious uveitis diagnosis and continuous insurance coverage during a 6-month baseline were selected from a privately insured claims database with 80.7 million enrollees. Index dates were defined as the first prescription/administration of a corticosteroid, immunosuppressant, or biologic between 2003 and 2009. Comorbidities, healthcare costs, and utilization were analyzed in a per-member-per-month (PMPM) framework to account for varying between-patient treatment periods, defined as continuous medication use within the same class. Wilcoxon rank-sum and chi-square tests were used for comparisons of costs and categorical outcomes. Results Patients on corticosteroids (N = 4,568), immunosuppressants (N = 5,466), and biologics (N = 1,694) formed the study population. Baseline PMPM inpatient admission rates were 0.029 for patients on corticosteroids, 0.044 for patients on immunosuppressants, and 0.045 for patients on biologics (p