Temporal artery biopsy: time for a rethink on training?

Background: Temporal artery biopsy (TAB) is often performed by ophthalmology trainees without direct supervision. The traditional model of 'see one, do one, teach one' still prevails in most units. Whilst it is generally a safe procedure, damage to the temporal branch of the facial nerve has been reported when harvesting the frontal branch of the superficial temporal artery.

Expression of Endogenous Putative TSH Binding Protein in Orbit.

Thyroid stimulating antibodies (TSAB) cause Graves' disease and contribute to Graves' Orbitopathy (GO) pathogenesis. We hypothesise that the presence of TSH binding proteins (truncated variants ()) and/or nonclassical ligands such as () might provide a mechanism to protect against or exacerbate GO. We analysed primary orbital preadipocyte-fibroblasts (OF) from GO patients and people free of GO (non-GO).

The Role of Mitochondria-Linked Fatty-Acid Uptake-Driven Adipogenesis in Graves Orbitopathy.

Context: Depot-specific expansion of orbital adipose tissue (OAT) in Graves orbitopathy (GO; an autoimmune condition producing proptosis, visual impairment and reduced quality of life) is associated with fatty acid (FA)-uptake-driven adipogenesis in preadipocytes/fibroblasts (PFs).

Objective: This work sought a role for mitochondria in OAT adipogenesis in GO.

Methods: Confluent PFs from healthy OAT (OAT-H), OAT from GO (OAT-GO) and white adipose tissue in culture medium compared with culture medium containing a mixed hormonal cocktail as adipogenic medium (ADM), or culture-medium containing FA-supplementation, oleate:palmitate:linoleate (45:30:25%) with/without different concentration of mitochondrial biosubstrate adenosine 5'-diphosphate/guanosine 5'-diphosphate (ADP/GDP), AICAR (adenosine analogue), or inhibitor oligomycin-A for 17 days.

Distinctive Features of Orbital Adipose Tissue (OAT) in Graves' Orbitopathy.

Depot specific expansion of orbital-adipose-tissue (OAT) in Graves' Orbitopathy (GO) is associated with lipid metabolism signaling defects. We hypothesize that the unique adipocyte biology of OAT facilitates its expansion in GO. A comprehensive comparison of OAT and white-adipose-tissue (WAT) was performed by light/electron-microscopy, lipidomic and transcriptional analysis using ex vivo WAT, healthy OAT (OAT-H) and OAT from GO (OAT-GO).

Quantitative Assessment of Orbital Decompression Surgery Using Photogrammetric Stereoimaging.

Purpose: To evaluate periorbital volume changes, using quantitative photogrammetric stereoimaging, after bony orbital decompression for thyroid eye disease (TED) and compare this to changes in Hertel exophthalmometry. Tissue volumes of the upper and lower eyelids were also assessed independently.

Design: Prospective, nonrandomized, nonconsecutive series of patients.

The first UK national blepharospasm patient and public involvement day; identifying priorities.

Purpose: We describe the planning and outcomes of the first 'Blepharospasm Day' in the UK. Blepharospasm is a distressing condition for patients and carers. Our 'patient and public involvement' event aimed to: cultivate a more informed patient group via active dialogue, help clinicians more effectively prioritise research and to facilitate peer-to-peer support for affected patients and public.

Prostaglandin F2-Alpha Eye Drops (Bimatoprost) in Graves' Orbitopathy: A Randomized Controlled Double-Masked Crossover Trial (BIMA Trial).

Background: Previous in vitro experiments have demonstrated that prostaglandin F2-alpha (PF) reduced proliferation and adipogenesis in a murine cell line and human orbital fibroblasts derived from subjects with inactive Graves' orbitopathy (GO). The objective of this study was to determine if the PGF analogue bimatoprost is effective at reducing proptosis in this population.

Methods: A randomized controlled double-masked crossover trial was conducted in a single tertiary care academic medical center.

Management of acute retrobulbar haemorrhage: a survey of non-ophthalmic emergency department physicians.

Introduction: Acute retrobulbar haemorrhage (RBH) with orbital compartment syndrome is a sight-threatening ophthalmic emergency requiring treatment with lateral canthotomy and cantholysis (LC/C). However, such cases may present to non-ophthalmic emergency departments (ED) out-of-hours, when specialist intervention is not readily available. We completed a survey of ED physicians to explore experiences of RBH and confidence in undertaking LC/C.

Adjustable versus non-adjustable sutures for strabismus.

Background: Strabismus, or squint, can be defined as a deviation from perfect ocular alignment and can be classified in many ways according to its aetiology and presentation. Treatment can be broadly divided into medical and surgical options, with a variety of surgical techniques being available, including the use of adjustable or non-adjustable sutures for the extraocular muscles. There exists an uncertainty as to which of these techniques produces a better surgical outcome, and an opinion that the adjustable suture technique may be of greater benefit in certain situations.

Case-control study of risk factors for acute corneal hydrops in keratoconus.

Purpose: To determine risk factors for the development of acute corneal hydrops in keratoconus in the UK in a case-controlled study.

Methods: Between November 2009 and December 2010, we prospectively identified 73 individuals who developed acute corneal hydrops. We then identified 174 controls from nine regions in the UK with keratoconus who had not had hydrops.

Periocular necrotising fasciitis: a multicentre case series.

Introduction: Necrotising fasciitis (NF) is a severe infection of deep subcutaneous soft tissues with high morbidity and mortality. Periocular necrotising fasciitis (PONF) is a very rare condition with many unanswered questions about the presentation and management. We present a retrospective case series of patients with PONF from three centres in Australia and two in the UK to investigate the clinical and microbiological characteristics and outcomes and report on patients treated with antibiotics alone.

Congenital cystic eye with optic nerve.

Congenital cystic eye (CCE) is a rare condition caused by failure of invagination of the optic vesicle resulting in a persistent cyst replacing the eye. An associated optic nerve attached to the cyst is a rarely reported phenomenon that has been sparsely described histologically, with no immunohistochemistry reported previously. The authors present a case of CCE with optic nerve tissue inserting into the cyst, and present the histological and immunohistochemical findings.

Surgical Management of Cicatricial Ectropion in Pityriasis Rubra Pilaris.

Pityriasis rubra pilaris is an idiopathic, papulosquamous dermatological disease. It is clinically and histologically distinct from, but may resemble, psoriasis. Pityriasis rubra pilaris can be self-limiting but may also run a protracted, relapsing course.

Ocular Findings in Alemtuzumab (Campath-1H)-induced Thyroid Eye Disease.

Alemtuzumab (Campath-1H) is a humanized anti-CD52 monoclonal antibody used in the treatment of multiple sclerosis (MS). Studies demonstrate significant reduction in relapse risk and the risk of accumulating sustained disability. Adverse events include infusion-associated reactions, infections, and secondary autoimmunity.

The versatility of the temporoparietal fascial graft (TPFG) in orbital implant exposure.

Background: The use of TPFGs for hydroxyapatite, porous polyethylene and silicone implant exposure has been described previously. To the authors' knowledge, this is the first description of this technique for acrylic implant exposure and paediatric patients.

Purpose: To demonstrate the versatility of the TPFG in orbital implant exposures of varying duration, implant types and patient age as well as for recurrent exposure.

Prolonged mydriasis after inadvertent topical administration of the calcium channel antagonist amlodipine: implications for glaucoma drug development.

Context: Calcium channel inhibitors are being investigated as potential therapeutic adjuncts to reduce painful ciliary muscle spasm and control intraocular pressure in glaucoma. Relatively little is known about the effect of topical administration of calcium channel blockers in humans.

Objective: (1) To describe prolonged fixed pupil dilation resulting from exposure to topical amlodipine (2) to review the evidence that links calcium channel blockers with mydriasis and (3) to discuss the implications for glaucoma pharmacotherapy.

Adjustable versus non-adjustable sutures for strabismus.

Background: Strabismus, or squint, can be defined as a deviation from perfect ocular alignment and can be classified in many ways according to its aetiology and presentation. Treatment can be broadly divided into medical and surgical options, with a variety of surgical techniques being available, including the use of adjustable or non-adjustable sutures for the extraocular muscles. There exists an uncertainty as to which of these techniques produces a better surgical outcome, and also an opinion that the adjustable suture technique may be of greater benefit in certain situations.

Intraoperative floppy iris syndrome (IFIS) in patients receiving tamsulosin or doxazosin-a UK-based comparison of incidence and complication rates.

Background: The association between intraoperative floppy iris syndrome (IFIS) and tamsulosin has been well-described. The rate of IFIS in association with other α-1 antagonists needs further clarification. The objective of this study was to determine the incidence of IFIS and associated cataract surgery complications in patients taking tamsulosin or doxazosin.

Perioperative spontaneous bilateral suprachoroidal hemorrhage.

Suprachoroidal hemorrhage is a rare condition, occurring most commonly in the perioperative period, although cases of unilateral spontaneous hemorrhages have been reported. We report a case of bilateral spontaneous suprachoroidal hemorrhage and discuss the potential causative factors.