To evaluate the safety and efficacy of intralesional pingyangmycin for treatment of orbital vascular malformations.

Thirteen patients received intralesional injections of pingyangmycin at the Eye and ENT Hospital of Fudan University. CT scans of each patient were evaluated with graphic processing software to measure lesion volumes before and after treatment.

Of five men and eight women patients averaging 36 years old, six were diagnosed with venous malformations, six with cavernous haemangiomas, and one with lymphangioma. Proptosis and eyelid swelling were the most common presenting signs. The mean preoperative lesion volume was 4.4±2.3 cm³ (range, 1.6–8.8 cm³), and the average postoperative volume was 1.5±1.7 cm³ (range, 0.2–6.6 cm³) after a single pingyangmycin injection, the dose of which averaged 4.2 mg (range, 2–6 mg). The mean percentage of volume reduction was 70.0% (range, 24.5–88.3%), whereas proptosis reduction averaged 3.2 mm (range, 0–5.5 mm). The lesion volume and proptosis reductions were both statistically significant (p<0.001, and p=0.001). No adverse local or systemic side effects occurred in any of the patients during follow-up averaging 13.3 months. Histopathology of a cavernous haemangioma that underwent a second injection through a surgical incision, showed a mild chronic inflammatory response, increased numbers of myofibroblasts, loss of vascularity and fibrosis, all consistent with known effects of bleomycin treatment.

Intralesional injection of pingyangmycin for the treatment of orbital vascular malformations is an effective method that involves mild inflammation, fibrosis, and reduced vascularity of the malformation.

We present a series of patients with acute suppurative bacterial dacryoadenitis and review the clinical presentation, microbiology, treatment options and outcome.

A multicentre, retrospective, case series review of patients with a clinical diagnosis of acute bacterial suppurative dacryoadenitis (ASBD). Records were examined to obtain information regarding patient demographics, presenting symptoms and signs, radiology, microbiology, management, outcomes and follow-up.

11 patients (9 men, 2 women; mean age 43.9 years, range: 6–82 years) were included. Average time to presentation was 2.8 days, and predisposing conditions were found in 45% of cases. Common presenting symptoms were eyelid swelling, pain, redness and diplopia, and common signs were ptosis, discharge and restriction of eye movements. The most common causative bacteria were Staphylococcus aureus and skin flora. Lacrimal gland swelling was universally seen on CT, with globe indentation of displacement in 27% of cases. Intravenous antibiotics were used in 91% of cases, which subsequently resolved over an average period of 9.7 days. Those with abscess formation (n=2) required incision and drainage.

ASBD is a rare condition that resolves quickly if managed appropriately. Underlying anatomical, infectious or inflammatory conditions should be investigated, and skin commensals should be covered with the instigation of antibiotic therapy.

We thank Dr Shoaib for the points raised1 regarding our recent article.2

It is difficult to compare results across studies because differing success criteria are often used, an issue which we mentioned in our discussion and believe should be addressed by future studies. In particular these outcome criteria do not take into account the initial characteristics of the patients studied or assess the control of their deviations. We chose the Pineles et al3 definition of ‘excellent’ as we wished to use a stringent outcome measure that included motor and sensory parameters. This does not mean that we intended the studies to be directly compared. The mean ages and duration of follow-up of children in the two studies are different, and 60% of the children in the Pineles et al study had had at least one further surgical procedure because of consecutive...

The GENEVA trial1 described the efficacy and safety of dexamethasone intravitreal implant (Ozurdex, Allergan) in treatment of patients with macular oedema due to post-retinal vein occlusion (RVO). However, this trial excluded RVO patients with a baseline best-corrected visual acuity (BCVA) of less than 34 Early Treatment of Diabetes Retinopathy Study (ETDRS) letters. We conducted a study of our clinical outcomes with Ozurdex in patients with macular oedema-associated central RVO (CRVO) and identified 19 patients with a baseline BCVA less than 34 ETDRS letters.

Medical records and optical coherence tomography (OCT) images of consecutive patients with macular oedema secondary to CRVO treated with Ozurdex between October 2010 and January 2012 in three centres in the northeast part of England were reviewed. Patients were seen at baseline and 1, 3 and 6 months after injection of Ozurdex. Treatment-naive CRVO patients with at least 6 months follow-up...

To investigate whether previous cyclodestructive (eg, cyclophotocoagulation and cyclocryodestruction) procedures have any influence on the general outcome and pressure level after glaucoma drainage device (GDD) surgery.

Retrospective analysis of 110 consecutive patients who had undergone GDD (Baerveldt 250 mm² and 350 mm² implant, AMO, USA) surgery with a minimum follow-up of 3 months. The patients were divided into patients with previous cyclodestructive surgery before GDD surgery (I; 47 patients) and patients without previous cyclodestructive surgery (II; 63 patients). Intraocular pressure (IOP), medication score, best-corrected visual acuity and surgical treatments were recorded before and after drainage device implantation.

Patients of group I had a mean preoperative IOP of 32.1 mm Hg and a mean medication score of 4.8; patients of group II had a mean preoperative IOP of 29.2 mm Hg (p=0.18) and a mean medication score of 4.9 (p=0.84). All patients who developed suprachoroidal haemorrhage (six cases) belonged to group I (6/47=12.8%), no patient of group II (0/63=0%) developed suprachoroidal haemorrhage (Fisher's test: p=0.01). Twelve patients developed late-onset (>6 weeks after GDD surgery) hypotony, nine of them belonging to group I (9/47=19.1%) and three of them to group II (3/63=4.8%) (Fisher's test: p=0.03).

While taking potential bias arising from the retrospective nature of the study into consideration, a history of previous cyclodestructive procedures before GDD surgery seems to be a major risk factor for suprachoroidal haemorrhage and for late-onset postoperative hypotony.

To identify and compare the profile of retinopathy of prematurity (ROP) in premature babies in urban and semiurban neonatal intensive care units (NICUs).

A prospective study of babies admitted to NICUs of two urban and seven semiurban centres. They were <36 weeks of gestational age and were subjected to fundus photography with a RetCam shuttle camera. Photos and NICU details were uploaded on a secure website. Photographs were read by a single observer. Infants were followed till retinal vascularisation was complete, or 45 weeks post conceptional age. Babies developing severe ROP were lasered.

500 babies were screened (243, urban group; 257, semiurban group). Incidence of ROP in the urban and semiurban groups was 16.5% (40) and 14.8% (38) respectively. Mean gestational age was 30.90 weeks and 31.53 weeks respectively. Mean birth weight was 1344 g and 1375 g respectively. 28 babies were lasered, 15 and 13 from each group respectively. There was no statistically significant difference between any of the parameters compared. Level of significance was fixed at 0.05.

The magnitude of the burden of ROP is comparable between urban and semiurban NICUs stressing the need for effective screening strategies in semiurban and rural areas as well.

To evaluate the intraoperative applicability and safety of a mixture of brilliant blue G and sodium hyaluronate (visco-BBG) for staining the inner limiting membrane (ILM).

A retrospective consecutive case series. Seventy-four eyes that had undergone ILM peeling were studied. During vitrectomy, ILM peeling with visco-BBG (visco-BBG group) was performed on 40 eyes; 12 with a macular hole (MH), 26 with an epimacular membrane (ERM) and 2 with a retinal detachment due to a MH (MHRD). ILM peeling with BBG dissolved in balanced salt solution (BSS-BBG group) was performed on 34 eyes; 9 with a MH, 23 with an ERM and 2 with a MHRD. The main outcome measures were the distribution of the dye within the vitreous cavity and the retinal sensitivity in the MH patients of the two groups by microperimetry.

The visco-BBG was injected over the retina where the ILM was intended to be peeled, and it stained the ILM in all cases. It did not disperse throughout the vitreous cavity or into the subretinal space. The BSS-BBG dispersed throughout the vitreous cavity, and its distribution was difficult to control. The two solutions did not stain the epiretinal membranes or any residual posterior hyaloid membrane. The difference in the retinal sensitivity between the two patients with MH of two groups was not significant. No complications were found in the visco-BBG group, although an accidental retinal perforation was found in one eye of the BSS-BBG group. Transmission electron microscopy confirmed that the membrane peeled was the ILM.

Visco-BBG can be a useful method to assist macular surgery and can overcome some of the disadvantages of conventional BBG solutions dissolved in BSS.

To evaluate the effect of topical diquafosol in patients with meibomian gland dysfunction (MGD) using tear film parameters and quantitatively analyse the meibomian gland morphology.

The subjects were 19 eyes of 10 patients diagnosed with obstructive MGD. All subjects were given 3% diquafosol ophthalmic solution with instructions to use one drop four times a day. Ocular symptoms were scored from 0 to 14. Lid margin abnormalities were scored from 0 to 4. Changes in the meibomian glands were scored using non-contact meibography (meiboscore). Superficial punctate keratopathy (SPK) was scored from 0 to 3. Meibum was graded from 0 to 3. Tear film production was evaluated by Schirmer's test. Quantitative image analysis of the meibomian glands was performed using the original software.

10 patients completed more than 4 months of therapy. Ocular symptoms, lid margin abnormalities, SPK score and meibum grade were decreased. Break-up time and tear film meniscus were increased. Mean ratio of the meibomian gland area was significantly increased after treatment (p<0.0001).

Quantitative image analysis was useful for evaluating the morphological changes of the meibomian glands. Topical diquafosol therapy was effective for patients with obstructive MGD.

To evaluate the efficiency of multimicroporous expanded polytetrafluoroethylene (e-PTFE) insertion in complicated multirecurrent pterygia.

A total of 62 eyes from 62 patients with a multirecurrent pterygium associated with symblepharon or motility restriction-related binocular diplopia were recruited. All eyes underwent pterygia excision followed by application of 0.033% mitomycin C, amniotic membrane transplantation and conjunctival limbal autograft. Multimicroporous e-PTFE was then inserted intraoperatively in 30 eyes between the transplanted amniotic membrane and the conjunctiva (group A), but not inserted in the other 32 eyes (group B). The main outcome measures were symblepharon formation, motility restriction, binocular diplopia, subjective score of conjunctival hyperaemia and postoperative pterygium recurrence.

In the mean follow-up period of 17.2±2.3 months, symblepharon formation, motility restriction, diplopia and conjunctival hyperaemia were significantly improved after surgery in group A patients (p=0.000, 0.000, 0.008 and 0.000, respectively). Postoperative symblepharon formation, motility restriction and conjunctival hyperaemia were significantly less in group A compared to group B (p=0.024, 0.027 and 0.000, respectively). After surgery, corneal recurrence developed in one eye (3.3%) from group A, which was significantly lower than the eight eyes (25%) from group B (p=0.027).

Multimicroporous e-PTFE insertion may provide a novel approach for treating intractable complicated multirecurrent pterygia.