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Microorganisms offer a sustainable way to increase crop production and promote eco-friendly farming. The endophytic fungus Metarhizium anisopliae is known for its multiple roles in plant ecosystems, including plant protection, symbiosis, and abiotic stress mitigation. In this study, we evaluated the potential of seed priming with M. anisopliae isolate MetA1 (MA) to enhance germination, photosynthetic efficiency, growth, and yield of two wheat varieties, BARI Gom 26 (BG26) and BARI Gom 33 (BG33) under field conditions. The study demonstrated that MA seed priming significantly improved wheat germination (by 13% and 26.04%) of BG26 and BG33, respectively. Overall, photosynthetic performance, indicated by increased leaf angle, leaf thickness, relative chlorophyll content, and linear electron flow (LEF), quantum yield of Photo System II (Phi2) was increased in MA primed wheat plants, while reducing non-photochemical quenching like NPQt, PhiNO, PhiNPQ of both varieties. These enhancements were attributed to increased shoot biomass (by 215.64% for BG26 and 280.38% for BG33), root biomass (by 141.79% for BG26 and 207.4% for BG33), effective tiller percentage (by 9.17% for BG26 and 5.7% for BG33), spike length (by 25.05% for BG26 and 25.42% for BG33), grain yield parameters such as filled grain percentage (by 23.8% for BG26 and 12.5% for BG33), and grain weight per plant (by 168.62% for BG26 and 119.62% for BG33). The findings of the research demonstrated the potential of M. anisopliae for field use in an agricultural setting, providing a sustainable means of increasing food production., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Bangladesh Agricultural Research Institute (BARI) released two beautiful Lilium varieties in 2020. In the same year the farmers in Gazipur district reported a set of disease symptoms on these flowers and alerted the Plant Pathology Division of BARI. Subsequent investigation confirmed the symptoms as Botrytis gray mold (BGM), caused by Botrytis cinerea . The pathogen identity was confirmed through ITS gene sequencing. A series of in vitro and in planta experiments conducted to understand the symptoms, the optimal growth condition for the pathogen, potential resistant Lilium genotypes, effective chemical treatments and potential of biological control agents to combat the disease. B. cinerea exhibited the highest growth in V8 media (88.55 mm) at pH6 (85.32 mm) and temperature between 20 and 25 °C (89.56 mm), and pH6 (85.32 mm). Screening revealed that five oriental-originated genotypes provided lower disease incidence (31.66-41.66 %), and were categorized as moderately resistant to resistant in disease reaction. Six fungicides successfully reduced mycelial growth in vitro . Moreover, Ipridione provided the lowest % disease incidence (27.11) and % disease severity (5.33) in the in planta nethouse experiment. Therefore, this fungicide was recommended to the farmers initially. Additionally, two fungal biocontrol agents Epicoccum nigrum EJS002 and Trichoderma ThC003, demonstrated effectiveness in reducing leaf lesion size over control in a detach leaf assessment technique. In conclusion, this study presents BGM of Lilium as a farmers issue for the first time in Bangladesh. It also provides valuable insights into its management, recommending specific chemical fungicides for farmers to use, and two fungal antagonists ( E. nigrum EJS002 and Trichoderma ThC003) as potential disease control agent., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Pulmonary mesenchymal tumors are uncommon neoplasms and the data available on their clinical, cytohistomorphological, immunohistochemical, and molecular findings are limited, leading to difficulty in timely diagnosis and management. Case 1: A 12-year-old boy presented with a right endobronchial mass. Imprint smears from endobronchial biopsy revealed moderately pleomorphic spindle cell tumor arranged in fascicles and perivascular pattern with attached myxoid material showing occasional mitotic activity suggesting a cytological diagnosis of sarcoma. Biopsy also displayed similar morphology. Extensive immunohistochemistry (IHC) showed diffuse SMA, focal AE1/AE3, and diffuse ALK positivity along with a MIB/Ki67 index of 30%-40% leading to the diagnosis of inflammatory myofibroblastic tumor (IMT; Sarcoma grade). Case 2: A 8-year-old boy presented with a huge left-sided mass replacing the entire lung parenchyma and eroding adjoining ribs. Pleural fluid cytology revealed vague clusters of PAS-positive diastase-sensitive small atypical cells with associated inflammatory cells in the hemorrhagic background, suggesting a diagnosis of malignant small round blue cell tumor. Trucut biopsy from the mass showed spindled to round cells showing diffuse positivity with CD99 and BCL-2. Molecular studies with reverse transcription-PCR (RT-PCR) for SYT-SSX and EWS-FLI1 were negative for synovial sarcoma and Ewing's sarcoma, respectively. Given the clinical setting, PAS positivity, IHC, and molecular studies, the diagnosis of tumors of uncertain differentiation with the possibility of Ewing's sarcoma family of tumors (ESFT) with a translocation between EWS1 and other ETS-family members (ERG, FEV, ETV1, E1AF, etc.) was suggested., (© 2024 Wiley Periodicals LLC.)

Soybean ( Glycine max L.) is an important crop in Asia, accounting for 17% of global soybean cultivation. However, this crop faces formidable challenges from the devastating foliar disease, Asian Soybean Rust (ASR), caused by Phakopsora pachyrhizi , a biotrophic fungus with a broad host range, causing substantial yield losses (10-100%) in Asia. This comprehensive review consolidates knowledge on ASR, encompassing its impact, historical perspectives, genetic diversity, epidemic drivers, early detection, risk assessment, and sustainable management strategies of ASR in the region. ASR has expanded globally from Asia, reaching Africa and Americas, driven by wind-dispersed urediniospores. Genetic diversity studies reveal the complexity of P. pachyrhizi , with distinct populations exhibiting varying virulence patterns. Factors affecting ASR epidemics in Asia include host susceptibility, landscape connectivity, climate, and environmental conditions. Understanding the interplay of these factors is essential for early intervention and control of ASR in soybean fields. Effectively managing ASR can exploit the utilization of diverse intervention strategies, encompassing disease forecasting, automated early detection, disease resistance, fungicide application, and biological control. A pivotal aspect of successful, sustainable disease management lies in reducing the ASR pathogen virulence and preventing it from developing fungicide resistance, while the highpoint of effectiveness in disease control is attained through a synergistic approach, integrating various strategies. In summary, this comprehensive review provides insights into multifaceted approaches that contribute to the development of sustainable and economically impactful soybean production in the face of the persistent threat of ASR in Asia., Competing Interests: NY has collaborative research with Kureha Corporation (Japan) involving research funding from the company. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Hossain, Sultana, Yesmin, Rubayet, Abdullah, Siddique, Bhuiyan and Yamanaka.)

Cinnamomum tamala (bay leaf) is widely used for culinary and medicinal purposes in South Asia. A leaf blight/spot disease was first discovered on nearly 90% of C. tamala plants with a mean severity of 48% to 74.4% in Gazipur and Bogura, Bangladesh, in 2019. The present study identified and characterized the causal organism and formulated the optimum growth conditions and effective fungicides for the chemical control of the pathogen. The characteristic symptoms on the infected leaves appeared circular to oval reddish-brown spots with raised margins and often developed in tear-stain patterns. Severe infection of C. tamala sapling resulted in dieback symptoms with leaf defoliation. A fungus with floccose, dense, white colonies with well-differentiated acervuli was isolated from the infected leaves. Combined cultural, morphological, and molecular characteristics identified the pathogen as Colletotrichum siamense. Inculcating healthy leaves and 1-year-old saplings of C. tamala with a conidial suspension of the fungus reproduced the same symptoms observed in the bay leaf orchard. The highest mycelial growth was recorded on V-8 Juice Agar media, while the maximum radial mycelial growth and level of sporulation of the fungus were significantly higher in incubation temperature 30°C. Fungicide trials showed that carbendazim 50 WP, azoxystrobin, mancozeb, and trifloxystrobin, either singly or in combination, successfully reduced fungal mycelial growth in vitro. Therefore, disease management strategies should be opted to halt the further spread of this issue. To our knowledge, this is the first study to document the incidence of Colletotrichum leaf blight on C. tamala in Bangladesh and even in the world., (© 2023 Wiley-VCH GmbH.)

A new disease of Cosmos sulphureus Cav. causing external and internal stem discoloration, premature death, and wilting was observed in 27.8% of plants with an average disease severity rating of 4.4 in Gazipur, Bangladesh. Morphological, pathological, and molecular analyses identified the isolated fungus as Sclerotinia sclerotiorum (Lib) de Bary, the causative agent of white rot disease. The optimum growth and sclerotium formation of S. sclerotiorum occurred at 20°C and pH 5.0, while glucose, peptone, yeast extract, casein, and ascorbic acid were the appropriate nutrient sources. Furthermore, mycelial growth and sclerotial development were favored in media containing potassium, magnesium, calcium, and sodium. As many as 20 plant species of 10 families; Calendula officinalisi, Chrysanthemum indicum, Catharanthus roseus, Solanum tuberosum, S. lycopersicum, S. melongena, Capsicum annum, Lablab purpureus, Phaseolus vulgari, Lens culinaris, Vigna radiata, Vigna mungo, Daucus carota, Raphanus sativus, Brassica juncea, Punica granatum, Spinacia oleracea, Ipomoea batatas, Ipomoea aquatica, and Elaeocarpus serratus were identified as the new hosts of the pathogen in Bangladesh. None of the C. sulphureus and Cosmos bipinnatus germplasms screened were genetically resistant to the pathogen. Among the tested fungicides, Autostin 50 WDG (carbendazim) and Rovral (Dicarboxamide) were most inhibitory to the fungus, while Autostin 50 WDG provided an efficient control of the pathogen in vivo up to 15 days after spray. The acquired results on characterization, physiology, host range, resistance, and fungicidal control of the pathogen could be valuable for effectively managing cosmos white rot in the field., (© 2022 Wiley-VCH GmbH.)

Lensless imaging has emerged as a potential solution towards realizing ultra-miniature cameras by eschewing the bulky lens in a traditional camera. Without a focusing lens, the lensless cameras rely on computational algorithms to recover the scenes from multiplexed measurements. However, the current iterative-optimization-based reconstruction algorithms produce noisier and perceptually poorer images. In this work, we propose a non-iterative deep learning-based reconstruction approach that results in orders of magnitude improvement in image quality for lensless reconstructions. Our approach, called FlatNet, lays down a framework for reconstructing high-quality photorealistic images from mask-based lensless cameras, where the camera's forward model formulation is known. FlatNet consists of two stages: (1) an inversion stage that maps the measurement into a space of intermediate reconstruction by learning parameters within the forward model formulation, and (2) a perceptual enhancement stage that improves the perceptual quality of this intermediate reconstruction. These stages are trained together in an end-to-end manner. We show high-quality reconstructions by performing extensive experiments on real and challenging scenes using two different types of lensless prototypes: one which uses a separable forward model and another, which uses a more general non-separable cropped-convolution model. Our end-to-end approach is fast, produces photorealistic reconstructions, and is easy to adopt for other mask-based lensless cameras.

Objective: To find out the effectiveness of the deep breathing exercises and incentive spirometryon arterial blood gases in second degree inhalation burn patients., Study Design: Randomised control trial., Place and Duration of Study: The study was conducted in the Burns Unit of PIMS Hospital, Islamabad from September 2017 to March 2018., Methodology: The data was collected on structured questionnaire using respiratory distress scoring and objective tools including arterial blood gases (ABGs) and vital signs with signed consent. There was random allocation of patients in the control and experimental groups. Baseline data was collected on day 00 and after completion of 14 sessions, it was recollected on day 07, and was assessed by using independent t-test and paired t-test. Both groups were given standard medical and nursing care. The experimental group was given single treatment regimen i.e. deep breathing exercises (given twice daily with 5-10 repetitions of each DBE possible onto patient for a period of 15-30 minutes). ISM was being performed on control group patients with 10-15 cycles along with steam inhalation and nebulization with beta 2 agonist for a period of 15-20 minutes for 35-45 minutes twice daily for a period of 07 days., Results: The male to female ratio was 7:8 in control group and 8:7 in the experimental group. The mean age was 29.6 ±6.66 years in the control group, and 38.4 ±4.91 years in the experimental group. The pH in arterial blood gas analysis of the experimental group was 7.33 (p=0.002) > pO2 was was 90.53 (p<0.001) and pCO2 was 41.61 (p=0.626). For control group, the pH in ABGs was 7.36 (p=0.268), pO2 was 88.06 (p=0.739) and pCO2 was 38.86 (p<0.001)., Conclusion: Deep breathing exercises are significant in improving pulmonary complications in patients of second degree inhalation burns.

Objective: To compare the length of hospital stay and return of bowel movement using the conventional management versus 'enhanced recovery after surgery' protocol., Methods: This study was conducted at the Civil Hospital, Karachi, from June 2014 to May 2015, and comprised patients undergoing stoma reversal. Patients were randomly allocated in two equal groups, i.e. A (treated with conventional peri-operative management) and B (with 'enhanced recovery after surgery' protocol). Prolonged ileus, wound infection and length of hospital stay between the two groups were compared. SPSS 20 was used for statistical analysis., Results: There were 60 participants who were divided into two groups of 30(50%) each. Overall, 39(65%) patients were males and 21(35%) were females. The mean age was 27.80±9.99 years in group A and 23.87±4.56 years in group B. Besides, 25(83%) patients in group A had prolonged ileus compared to 3(10.7%) in group B (p=0.00). Moreover, 14(46.7%) patients in group A and 8(26.7%) patients in group B had wound infection (p=0.10). The mean duration of hospital stay was also less in group B compared to group A (p<0.05)., Conclusions: The application of 'enhanced recovery after surgery' protocol was found to be safe.

Background & Aims: Quality measures are used to standardize health care and monitor quality of care. In 2011, the American Gastroenterological Association established quality measures for inflammatory bowel disease (IBD), but there has been limited documentation of compliance from different practice settings., Methods: We reviewed charts from 367 consecutive patients with IBD seen at academic practices, 217 patients seen at community practices, and 199 patients seen at private practices for compliance with 8 outpatient measures. Records were assessed for IBD history, medications, comorbidities, and hospitalizations. We also determined the number of patient visits to gastroenterologists in the past year, whether patients had a primary care physician at the same institution, and whether they were seen by a specialist in IBD or in conjunction with a trainee, and reviewed physician demographics. A univariate and multivariate statistical analysis was performed to determine which factors were associated with compliance of all core measures., Results: Screening for tobacco abuse was the most frequently assessed core measure (89.6% of patients; n = 701 of 783), followed by location of IBD (80.3%; n = 629 of 783), and assessment for corticosteroid-sparing therapy (70.8%; n = 275 of 388). The least-frequently evaluated measures were pneumococcal immunization (16.7% of patients; n = 131 of 783), bone loss (25%; n = 126 of 505), and influenza immunization (28.7%; n = 225 of 783). Only 5.8% of patients (46 of 783) had all applicable core measures documented (24 in academic practice, none in clinical practice, and 22 in private practice). In the multivariate model, year of graduation from fellowship (odds ratio [OR], 2.184; 95% confidence interval [CI], 1.522-3.134; P < .001), year of graduation from medical school (OR, 0.500; 95% CI, 0.352-0.709; P < .001), and total number of comorbidities (OR, 1.089; 95% CI, 1.016-1.168; P = .016) were associated with compliance with all core measures., Conclusions: We found poor documentation of IBD quality measures in academic, clinical, and private gastroenterology practices. Interventions are necessary to improve reporting of quality measures., (Copyright © 2016 AGA Institute. Published by Elsevier Inc. All rights reserved.)

Cells can innately recognize generic products of viruses, bacteria, fungi, or injured tissue by engagement of pattern recognition receptors. Innate immune cells rapidly respond to this engagement to control commensals, thwart pathogens, and/or prompt repair. Insufficient or excessive activation of the innate immune response results in disease. This review focuses on pattern recognition receptors and cells of the innate immune system that are important for intestinal function. Our improving knowledge pertaining to this important aspect of our immune response is opening potential important new therapeutic opportunities for the treatment of disease., (Copyright © 2014 AGA Institute. Published by Elsevier Inc. All rights reserved.)

Purpose: To compare the incidence of long-term complications after cataract surgery with primary anterior chamber intraocular lens (AC IOL) implantation in uveitic patients and patients without a history of intraocular inflammation (control group)., Setting: Single-center private practice., Design: Retrospective clinical study., Methods: The study comprised patients who between November 2005 and August 2010 had cataract extraction followed by AC IOL implantation because conventional placement was not possible. Outcome measures were the incidence of intraoperative and postoperative complications, preoperative corrected distance visual acuity (CDVA), and CDVA after 1 year., Results: Of the 39 patients identified through electronic medical records, 17 (17 eyes) had a history of chronic uveitis and 22 (23 eyes) had no intraocular inflammatory disease. There were no significant differences in the incidence of intraoperative and postoperative complications between the 2 groups during follow-up (range 12 to 68 months) (P=.702). Although uveitic eyes had a greater risk for epiretinal membrane formation, the incidence of uveitis flareups attributed to the IOL and deposits on IOL surfaces was comparable to that in the control group (P<.001). The CDVA improved significantly in both groups 1 year after surgery (P<.01 and P<.001, respectively)., Conclusion: In uveitic eyes with inadequate capsule support, AC IOL implantation restored visual function without a significant increase in long-term postoperative complications compared with eyes that had no history of uveitis., (Copyright © 2013 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Background: A novel sarcomeric myosin heavy chain gene, MYH14, was identified following the completion of the human genome project. MYH14 contains an intronic microRNA, miR-499, which is expressed in a slow/cardiac muscle specific manner along with its host gene; it plays a key role in muscle fiber-type specification in mammals. Interestingly, teleost fish genomes contain multiple MYH14 and miR-499 paralogs. However, the evolutionary history of MYH14 and miR-499 has not been studied in detail. In the present study, we identified MYH14/miR-499 loci on various teleost fish genomes and examined their evolutionary history by sequence and expression analyses., Results: Synteny and phylogenetic analyses depict the evolutionary history of MYH14/miR-499 loci where teleost specific duplication and several subsequent rounds of species-specific gene loss events took place. Interestingly, miR-499 was not located in the MYH14 introns of certain teleost fish. An MYH14 paralog, lacking miR-499, exhibited an accelerated rate of evolution compared with those containing miR-499, suggesting a putative functional relationship between MYH14 and miR-499. In medaka, Oryzias latipes, miR-499 is present where MYH14 is completely absent in the genome. Furthermore, by using in situ hybridization and small RNA sequencing, miR-499 was expressed in the notochord at the medaka embryonic stage and slow/cardiac muscle at the larval and adult stages. Comparing the flanking sequences of MYH14/miR-499 loci between torafugu Takifugu rubripes, zebrafish Danio rerio, and medaka revealed some highly conserved regions, suggesting that cis-regulatory elements have been functionally conserved in medaka miR-499 despite the loss of its host gene., Conclusions: This study reveals the evolutionary history of the MYH14/miRNA-499 locus in teleost fish, indicating divergent distribution and expression of MYH14 and miR-499 genes in different teleost fish lineages. We also found that medaka miR-499 was even expressed in the absence of its host gene. To our knowledge, this is the first report that shows the conversion of intronic into non-intronic miRNA during the evolution of a teleost fish lineage.

The myosin heavy chain gene, MYHM86-2, exhibited restricted expression in slow muscle fibers of torafugu embryos and larvae, suggesting its functional roles for embryonic and larval muscle development. However, the transcriptional mechanisms involved in its expression are still ambiguous. The present study is the first extensive analysis of slow muscle-specific MYHM86-2 promoter in fish for identifying the cis-elements that are crucial for its expression. Combining both transient transfection and transgenic approaches, we demonstrated that the 2614bp 5'-flanking sequences of MYHM86-2 contain a sufficient promoter activity to drive gene expression specific to superficial slow muscle fibers. By cyclopamine treatment, we also demonstrated that the differentiation of such superficial slow muscle fibers depends on hedgehog signaling activity. The deletion analyses defined an upstream fragment necessary for repressing ectopic MYHM86-2 expression in the fast muscle fibers. The transcriptional mechanism that prevents MYHM86-2 expression in the fast muscle fibers is mediated through Sox6 binding elements. We also demonstrated that Sox6 may function as a transcriptional repressor of MYHM86-2 expression. We further discovered that nuclear factor of activated T cells (NFAT) binding elements plays a key role and myocyte enhancer factor-2 (MEF2) binding elements participate in the transcriptional regulation of MYHM86-2 expression., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Purpose: To report the outcomes of infliximab treatment of birdshot retinochoroidopathy (BSRC) refractory to conventional immunomodulatory therapy., Design: Retrospective case series., Participants: Twenty-two refractory birdshot retinochoroidopathy patients (44 eyes) who received infliximab between July 2005 and June 2012 were identified by retrospective chart review., Methods: All patients received 4 to 5 mg/kg infliximab at 4- to 8-week intervals. Data regarding patient demographics, use of immunosuppressive drugs, biologic agents, and reason for conventional therapy discontinuation were gathered. Disease activity markers, including signs of ocular inflammation, fluorescein angiography evidence of retinal vasculitis or papillitis, indocyanine green angiography evidence of active choroiditis, electroretinography parameters indicative of stable or worsening of retinal functions, and optical coherence tomography findings indicative of static or worsening macular edema were recorded., Main Outcome Measures: Abolition of all evidence of active inflammation, visual acuity (VA), presence of cystoid macular edema at 6 months and 1 year, and adverse responses to infliximab., Results: Mean duration of disease before starting infliximab was 58.6 months. Before infliximab therapy, all patients received and failed conventional immunosuppressive therapy. Ten patients had received another biologic agent. After initiating infliximab, control of inflammation was achieved in 81.8% at 6 months and in 88.9% at the 1-year follow-up. Three patients had active inflammation during therapy. The rate of cystoid macular edema decreased from 22.7% at baseline to 13.9% at 6 months and 6.7% at 1 year after receiving the drug. Initial VA of 20/40 or better was found in 34 eyes (84.1%). At 6 months and 1 year, 91.7% and 94.4% of eyes, respectively, had VA of 20/40 or better. Six patients had adverse events; infliximab therapy was discontinued in these patients because of neuropathy, drug-induced lupus, allergic reaction, or fungal infection., Conclusions: The data suggest that infliximab is effective for controlling inflammation in otherwise treatment-refractory cases of BSRC., (Copyright © 2013 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Despite its relative rarity, uveitis is the third leading cause of preventable blindness worldwide. Glaucoma associated with uveitis is one of the most serious complications of intraocular inflammation. We review in detail the epidemiology and pathogenesis of uveitic glaucoma and the safety and efficacy of the current medical and surgical treatment modalities., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Purpose: We investigated the expression of IL-1, IL-6, IL-12, IL-13, and IL-17 in the conjunctiva of patients with ocular cicatricial pemphigoid (OCP), also labeled as ocular mucous membrane pemphigoid (MMP)., Methods: A retrospective case-control study was done on 5 biopsy-proven OCP subjects and 6 healthy volunteers. Conjunctival specimens were obtained, and the local expression of IL-1, IL-6, IL-12, IL-13, and IL-17 was studied by immunohistochemistry. Clinical and therapeutic features were collected during follow-up., Results: No remarkable IL-1, IL-6, IL-12, IL-13, or IL-17 expression was observed in normal conjunctival specimens. All OCP samples had remarkable amounts of IL-12 and IL-17 expression especially in the epithelium and stroma; there also was stromal overexpression of IL-6. The mean follow-up after the biopsy was 13 months (range 9-15 months)., Conclusions: Our results demonstrated, for the first time to our knowledge, a local overexpression of IL-6, IL-12, and IL-17 in conjunctiva of OCP compared to controls.

Purpose: To compare the visual outcomes and prevalence of long-term complications in patients with quiescent uveitis after phacoemulsification with traditional in-the-bag intraocular lens (IOL) implantation versus primary or secondary anterior chamber (AC) IOL implantation due to inadequate capsule support., Setting: Single-center private practice., Design: Retrospective observational cohort study., Methods: Patients with quiescent uveitis who had cataract surgery with subsequent AC IOL implantation were identified through an electronic medical record database. They were age matched with patients with uveitis who had conventional placement of a posterior chamber (PC) IOL. The rate of postoperative complications and corrected distance visual acuity (CDVA) were reviewed preoperatively and 1, 3, and 6 months and 1, 2, 3, and 4 years postoperatively., Results: The incidence of postoperative complications was not statistically different for any criterion except posterior capsule opacification development in the PC IOL cohort (relative risk, 0.071). The mean follow-up was 36.11 months ± 17.3 (SD) in the AC IOL group and 53.72 ± 20.4 months in the PC IOL group. The mean preoperative CDVA was 1.49 ± 1.07 logMAR in the AC IOL group and 0.5 ± 0.26 logMAR in the PC IOL group. Both groups had a significant improvement in CDVA visual acuity 3 years postoperatively (P=.001 and P=.010 respectively)., Conclusions: In uveitic eyes with inadequate capsule support, AC IOL implantation was safe and effective in providing satisfactory improved CDVA without a significant increase in long-term complications compared with eyes that had PC IOL placement., (Copyright © 2012 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Cataract surgery in patients with uveitis is not as simple as any senile cataract surgery. Recent evidence suggests that useful visual outcome can be achieved in most of the cases if they are handled meticulously. Key factors leading to improved visual outcome are absolute control of preoperative inflammation with diligent use of immunomodulatory drugs, meticulous surgery along with early detection and care of postoperative complications. Modern technologies in the intraocular lens designs and materials have contributed to the success. In this article, we review the literature on this subject with emphasis on the importance of the use of immunomodulatory drugs to control preoperative and postoperative intraocular inflammation and avoid complications.

Purpose: There is widespread misinterpretation of normal conjunctival fibrinogen. In differentiating between normal conjunctiva and cicatrizing conjunctivitis, including ocular cicatricial pemphigoid, atopic keratoconjunctivitis, and lichen planus, it is important to properly evaluate and characterize the histologic appearance of the structures seen and not base a diagnosis on just the presence or absence of certain features. One feature of conjunctival histology prone to misinterpretation and misdiagnosis is the presence of subepithelial fibrinogen, particularly when the diagnosis of lichen planus is being considered. Although the presence of subepithelial fibrinogen in oral mucous membranes and in skin can be indicative of lichen planus, such is not the case for conjunctiva. An erroneous diagnosis of lichen planus based on the presence of conjunctival subepithelial fibrinogen can initiate prolonged treatment with topical steroids leading to avoidable, blinding, complication, and further, delay therapy for the real cause of the conjunctivitis. We conducted a cross sectional, controlled, blinded and prospective Institutional Review Board-approved study on the occurrence and pattern of fibrinogen at the epithelial basement membrane zone (BMZ) of normal and inflamed conjunctiva., Methods: Bulbar conjunctiva was obtained from 10 cases of undiagnosed chronic conjunctivitis of at least 6 months duration and 8 patients with normal conjunctiva. Immunofluorescent staining with antifibrinogen antibodies, periodic acid-schiff stain (PAS), and Giemsa staining were performed., Results: BMZ fibrinogen was found in all cases. This layer was linear, smooth, and continuous in normal conjunctiva and 7 cases of chronic conjunctivitis. It was fragmented and lumpy in 1 case of ocular cicatricial pemphigoid (OCP) and showed spikes and spurs in 2 cases of lichen planus., Conclusions: BMZ fibrinogen is a normal component of the conjunctiva and its morphological features rather than its mere presence should be assessed as a diagnostic tool.

Purpose: To report the long-term outcomes of Boston keratoprosthesis type II implantation in the management of severe ocular surface disease and corneal blindness through a retrospective interventional case series., Methods: This retrospective review included medical records of patients who underwent Boston keratoprosthesis type II implantation at the Massachusetts Eye and Ear Infirmary from January 1, 2000 through December 31, 2009. The main outcome measures analyzed were visual acuity, keratoprosthesis retention, and postoperative complications., Results: A total of 29 eyes of 26 patients received a Boston keratoprosthesis type II during the study period. Patients undergoing operation had corneal blindness because of mucous membrane pemphigoid (51.7%), Stevens-Johnson syndrome/toxic epidermal necrolysis (41.4%), or other ocular surface disease (6.9%). Visual acuity after surgery improved to 20/200 or better in 23 eyes (79.3%) and to 20/30 or better in 10 eyes (34.5%). In patients with at least 1 year of follow-up (n = 21), visual acuity of 20/200 or better was maintained in 12 eyes (57.1%). Of 13 eyes followed-up for more than 5 years, 6 eyes (46.2%) had visual acuity of 20/200 or better at the last follow-up examination. Eyes that did not improve to 20/200 or lost vision during the follow-up had end-stage glaucoma, previous retinal detachment, or age-related macular degeneration. Of the total of 29 eyes, 17 devices (58.6%) were retained without extrusion or replacement during a total follow-up time of 107.9 person-years., Conclusions: The Boston keratoprosthesis type II is a viable option for corneal blindness from severe autoimmune ocular surface diseases.

Introduction: Although uveitis remains the third leading cause of preventable blindness in the US, the care and management of patients with uveitis and ocular inflammatory disease sit poised to make evolutionary if not revolutionary changes in the years ahead. This review serves to highlight important advances in the pharmacologic options available for the treatment of uveitis and ocular inflammation., Areas Covered: Advances in steroid therapy (both topical and extended delivery), updates in the clinical safety of systemic immune modulation, and the emerging therapies for uveitis and ocular inflammatory disease are some of the areas covered in this review., Expert Opinion: Corticosteroids have been the mainstay in the care of patients with ocular inflammatory disorders for many years. Indeed, some physicians still use only steroids for treating inflamed eyes. However, the mission is remission of all corticosteroids in order to prevent the complications associated with long-term corticosteroid use. The goal is to achieve quiescence through aggressive use of corticosteroids to extinguish the fire and then move along to achieve steroid-free remission through immunosuppressant agents.

Ocular inflammatory disease is the third leading cause of blindness in the United States. In addition to the conventional immunomodulatory agents, which include antimetabolites, alkylating agents, and antibiotics such as cyclosporine, many of which have been used in the treatment of this disease for decades, several new treatment modalities have emerged within the past 10 years. We review in detail the characteristics, safety, and efficacy of the conventional immunomodulators, the more novel agents such as the biologics, and investigational drugs that appear promising in the treatment of ocular inflammatory disease., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Purpose: To report a case of herpetic keratitis in a patient undergoing mitomycin C therapy for conjunctival squamous cell carcinoma., Method: Case report., Results: A 70-year-old man was referred to the Massachusetts Eye Research and Surgery Institution in consultation for a persistent redness in the right eye. He was diagnosed with conjunctival squamous cell carcinoma and treated with topical mitomycin C (MMC). The patient initially improved on topical MMC therapy. At the end of the second cycle of topical MMC, he complained of intense ocular pain and redness in the eye under treatment. A diagnosis of herpetic epithelial keratitis was made based on the clinical findings, and he was subsequently treated with 1 drop of trifluridine 9 times per day in the affected eye. The patient responded with dramatic improvement and resolution of symptoms., Conclusions: This case reports a reactivation of latent herpes simplex virus with productive ocular infection, triggered by MMC therapy and highlights the importance of awareness of this possible risk associated with the use of MMC.

Purpose: To report on a patient with congenital erythropoietic porphyria who presented with scleral necrosis., Method: Case report., Results: A 34-year-old man with a long history of congenital erythropoietic porphyria was referred to us for evaluation of necrotizing scleritis of the right eye. The patient presented with a 3-month duration of eye pain and redness, which initially responded to oral and topical corticosteroids. However, upon corticosteroid taper, the symptoms quickly recurred. The patient was initially tried on oral azathioprine therapy, which failed to induce resolution of the symptoms. Full serological investigation did not suggest that the necrotic process was secondary to an immunologically driven process, and we proceeded with scleral biopsy and patch graft. The biopsy disclosed atrophic changes of the sclera with calcium-like plaques, without evidence of inflammation. Aggressive strategy of sun avoidance was implemented and immunosuppressive therapy discontinued. One year after the surgery, the patient remains asymptomatic without recurrence of ocular disease., Conclusions: This case highlights the usefulness of tissue biopsy in porphyria when one is uncertain as to whether a necrotizing process is driven by inflammation or phototoxic damage. When the underlying mechanism is clearly identified, the appropriate therapy can then be instituted to prevent further damage.