Neuromyelitis optica spectrum disorders and anti-myelin oligodendrocyte glycoprotein positive optic neuropathies

AIM: To describe the clinical characteristics and treatments associated with antibody positive optic neuropathies including anti-myelin oligodendrocyte glycoprotein(MOG) and anti-aquaporin 4(AQP4), alongside diagnostic modalities, investigations, and outcomes. METHODS: A cross-sectional single-centre retrospective case series consisting of 16 patients including 12 antiMOG positive patients and 4 anti-AQP4 positive patients. Each of these patients had clinical signs and symptoms of optic neuritis and consisted of all patients who had a positive blood antibody result in our centre. Clinical findings including presence of a relative afferent pupillary defect, colour vision and disc assessment were recorded. Structured clinical exam and multimodal imaging was undertaken sequentially on each. Optical coherence tomography(OCT) scanning was preformed to examine the correlation between ganglion cell layer(GCL) thickness and visual acuity(VA) at presentation and as a determinant of final visual outcome in both groups. Initial and long-term treatment is also summarised. RESULTS: A total of 16 patients were included in the study consisting of 12 anti-MOG and 4 anti-AQP4 positive patients. Nine of the 16 patients were female and the average age of onset was 29.2 y in the MOG group and 42 y in the AQP4 group. There was no statistically significant correlation(Pearson correlation) between GCL thickness and presenting and final VA [r(10)=0.081, P=0.08 and r(10)=0.089, P=0.34 respectively]. The same statistical analysis was performed for the correlation between retinal nerve fibre layer(RNFL) and VA and similar outcomes wereobserved [r(10)=0.04, P=0.22 and r(10)=0.09, P=0.04]. No correlation was seen for initial RNFL thickness and final visual outcome in this group either [r(2)=0.19, P=0.38]. Visual field testing and radiological findings for each group are described. CONCLUSION: No correlation between initial VA or RNFL and final visual outcome is identified. A broad range of visual field and radiographic findings are identified, a consensus on treatment of neuromyelitis optica spectrum disorders and anti-MOG positive optic neuropathies has yet to be accepted but initial high dose immunosuppression followed by low dose maintenance therapy is favoured.

Role of human papillomavirus in oropharyngeal squamous cell carcinoma: A review

Human papillomavirus(HPV) has been implicated in the pathogenesis of a subset of oropharyngeal squamous cell carcinoma. As a result, traditional paradigms in relation to the management of head and neck squamous cell carcinoma have been changing. Research into HPVrelated oropharyngeal squamous cell carcinoma is rapidly expanding, however many molecular pathological and clinical aspects of the role of HPV remain uncertain and are the subject of ongoing investigation. A detailed search of the literature pertaining to HPV-related oropharyngeal squamous cell carcinoma was performed and information on the topic was gathered. In this article, we present an extensive review of the current literature on the role of HPV in oropharyngeal squamous cell carcinoma, particularly in relation to epidemiology, risk factors, carcinogenesis, biomarkers and clinicalimplications. HPV has been established as a causative agent in oropharyngeal squamous cell carcinoma and biologically active HPV can act as a prognosticator with better overall survival than HPV-negative tumours. A distinct group of younger patients with limited tobacco and alcohol exposure have emerged as characteristic of this HPV-related subset of squamous cell carcinoma of the head and neck. However, the exact molecular mechanisms of carcinogenesis are not completely understood and further studies are needed to assist development of optimal prevention and treatment modalities.

Inner blood-retina barrier involvement in dry age-related macular degeneration(AMD) pathology

Age-relatedmaculardegeneration(AMD)isaprogressiveneurodegenerative disease with a global prevalence of 8.7%in people over the age of 45. It is one of the leading causes of central retinal blindness in the industrialized world leading to loss of an individual’s ability to read, drive and see fine details, such as recognition of faces. By 2040, it is estimated that 288 million individuals worldwide will be diagnosed with AMD due to improved life expectancy(Wong et al., 2014).

Alcohol delamination of the corneal epithelium for recurrent corneal erosion syndrome

AIM： To evaluate the outcomes of alcohol delamination（ALD） of the corneal epithelium for the treatment of recurrent corneal erosion syndrome（RCES） and to implement a standardized treatment protocol for this condition utilizing evidence based practice and the findings of an internal audit. METHODS： A retrospective analysis of 42 eyes of 40 patients diagnosed with RCES who were treated with ALD between January 2006 and March 2016 was conducted. Patients had 20% alcohol applied to the cornea with the use of a well for 40 s. Patients were reviewed one week later in the Outpatient Department. Outcome criteria were established based on standards from other studies in the medical literature. These included, a treatment success rate of at least 72%（defined as complete resolution of symptoms one month after treatment）, a postoperative complication a rate of 〈5%（mainly infective keratitis, and subepithelial haze）, and the absence of any detrimental effect on visual acuity in ≥95% of patients. RESULTS： The mean age at the time of ALD was 41.17±13.44 y. Patients were followed for an average of 12.8±15.65 mo. The majority were female（52.5%, n=21） and the majority of eyes treated with ALD were left eyes（62.9%, n=26）. Trauma was the primary aetiology in our study population. Treatment was successful in 73.8%（n=31） of eyes and in 75%（n=30） of patients. Recurrence occurred in 26.2% of eyes at a mean of 10.41±12.63 mo post treatment. CONCLUSION： ALD is an efficacious and cost-effective primary surgical intervention for RCES.

Systemic IL-1β production as a consequence of corneal HSV-1 infection-contribution to the development of herpes simplex keratitis

This study sought to identify potential therapeutic targets in herpes simplex keratitis(HSK) patients with active and inactive infection by investigating peripheral cytokine production. Peripheral blood mononuclear cells(PBMCs) and serum were prepared from healthy controls and HSK patients during active infection or following treatment(inactive infection). Serum antibody titres were determined by ELISA. Protein expression levels were analysed by Western blot. Cytokine levels were determined by multiplex ELISA. Active corneal herpes simplex virus type 1(HSV-1) infection resulted in significantly elevated peripheral levels of IL-1β in HSK patients compared to healthy controls, and remained significantly increased following treatment. Elevated production of IL-1β in inactive patients was associated with significantly increased levels of IRF3 and STAT1, key proteins involved in promoting anti-viral immune responses. Our data suggest that inflammation persists beyond the period that it is clinically evident and that enhanced peripheral production of IL-1β may have implications for HSV-1 viral clearance in active and inactive HSK patients.

成人鼻腔泪囊插管的长期随访

Background/aims:The authors have previously reported a short term mean 15 month follow up of nasolacrimal intu bation in adults.The effectiveness of this procedure for long term(mean 78 months)control of epiphoria is assessed here.Methods:65 eyes from 40 patients who underwent nasolacrimal intubation were followed.Mean age at intubation was 59.2 years.The mean follow up period was 6.2 years.The results were based on long term symptomatic improvement.Results:Complete long term resolution of symptoms was reported in 50.7%.A partial improvement was reported in 38.5%,and no improvement in 10.7%.A better outcome was associated with a canalicular than nasolacrimal duct obstruction.On long term follow up 16.9% required dacrocysto-rhinostomy(DCR).Conclusion:Nasolacrimal intubation,a minimally invasive procedure is successful in the long term control of epiphora.Selection of patients with canalicular duct obstruction gives higher success rates with fewer patients subsequently requiring the DCR procedure.