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Hypokalaemic periodic paralysis (HPP) is an uncommon complication of corticosteroid therapy, which may also be seen in thyrotoxicosis. It was mostly described in the Asian population, and it is rare in other ethnic groups. We present the case of a poorly controlled thyrotoxic Caucasian male with thyroid eye disease (TED) who suffered an acute quadriplegic episode caused by severe hypokalaemia and was admitted to the intensive care unit (ITU) within 24 hours of initiating intravenous methylprednisolone (IVMP) infusion. Once his potassium blood levels were repleted, he completely recovered from the episode. Although HPP is rare in the Caucasian population, it can be precipitated in thyrotoxic patients by systemic steroids. Caution should be exercised when administering IVMP in poorly controlled thyrotoxic patients, and we suggest monitoring the potassium levels at regular intervals with ECG monitoring for at least 24 hours in at-risk individuals.

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PURPOSE: To report a case of an unusual presentation of a glomus jugulare tumour. DESIGN: Case report. RESULTS: Glomus jugulare is a very rare brain tumour that usually presents with tinnitus, hearing loss, dysphagia and hoarseness. We report a case where this extremely rare diagnosis presented quite differently, with ipsilateral proptosis and subsequent facial nerve palsy. Furthermore, the sibling of the presented case had also been diagnosed with the same tumour. CONCLUSIONS: There have only been a few case reports in the literature describing facial nerve palsy in the context of a glomus jugulare tumour. This case highlights that although paragangliomas are exceedingly rare causes of facial palsy, they should be included in the differential diagnosis.

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Prostaglandin F2 alpha (PGF2a) analogues including bimatoprost and travoprost are used worldwide, often as first line topical treatments for glaucoma. We present 2 cases of a newly described side effect of both these topical agents in terms of periorbital fat atrophy. This visually noticeable side effect had features demonstrable on MRI scanning. The periorbital fat atrophy is most apparent with uniocular use and both doctors and patients need to be aware of this side effect before commencing treatment. The effects, however, appear to be reversible with treatment cessation.

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Exogenous brain derived neurotrophic factor (BDNF) is known to rescue ganglion cell death after optic nerve injury. Its mechanism of action is believed to be indirect via glial cells in the retina. In this study we investigated the changes in expression and localisation of BDNF, neurotrophin-4 (NT4) and their common receptor (TrkB) in retinectomy sections of patients with proliferative vitreoretinopathy (PVR). Nine full-thickness retinectomy specimens obtained at retinal reattachment surgery for PVR were fixed in 4% paraformaldehyde immediately after excision and compared to similarly processed normal donor retinas (4 eyes). Agarose-embedded sections (100 microm thick) were double labelled for immunohistochemistry by confocal microscopy, with antibodies against BDNF, NT4, TrkB, rod opsin, glial fibrillary acidic protein (GFAP), cellular retinaldehyde binding protein (CRALBP) and Brn3. This study demonstrates expression of NT4 by ganglion cells and shows expression of BDNF and NT4 in the outer photoreceptor segments is downregulated during PVR, whilst NT4 is markedly upregulated throughout the retina during this condition. The findings here suggest that NT4 may play a neural protective role during the development of PVR. It also shows that upregulation of NT4 in PVR is localised to Müller glial cells, indicating either over-expression of this factor by Müller cells or that Müller cells internalise NT4 for trafficking across the retina. TrkB expression was not observed in PVR retina. The observations that Müller glia demonstrate upregulation of NT4 suggests that retinal injury may lead to activation of this neurotrophin by Müller cells as part of their neuroprotective functions.

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Racemose haemangioma of the retina is a rare, usually unilateral developmental abnormality: an arteriovenous communication with variable alterations in capillary and arteriolar networks. Herein a case of a 57-year-old man with a vitreous and subretinal haemorrhage in the left eye is described.

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The distinction between penetrating eye injury with retained intraocular foreign body and perforating globe injuries is not always easy clinically. The case is presented of a 25-year-old man who sustained a perforating eye injury that was through a clear self-sealing corneal entry site and had no conjunctival or periorbital injury. He had periorbital ecchymosis on presentation suggesting that the globe had been perforated with resulting retro-orbital blood tracking to the periorbital region. This sign would not be expected had the foreign body remained intraocular. The management options of these cases are discussed.

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PURPOSE: To evaluate the functional and anatomical results of macular hole surgery and to explore its effect on patients' Health-Related Quality Of Life (HR-QOL) and to investigate the associations between self-reported HR-QOL and conventional measures of visual function. DESIGN: Case series. METHODS: The National Eye Institute 25-Item Visual Function Questionnaire (VFQ-25) and the 36-Item Short-Form Health Survey (SF-36) were self-administered by 30 patients before and 4 months after macular hole surgery. Preoperative, intraoperative, and postoperative clinical data were collected including visual acuity, contrast sensitivity, and metamorphopsia. Multi-item scales rating different aspects of HR-QOL were compared before and after surgery, and their correlation with traditional methods of outcome evaluation was analyzed. RESULTS: Macular hole closure was achieved in 26 patients (87%). Mean LogMAR visual acuity improved by 6 +/- 10 letters for distance and 7 +/- 12 letters for near. Metamorphopsia was reduced by a mean of 35 +/- 70 squares on Amsler chart, and Pelli-Robson contrast sensitivity decreased by a mean of -0.09 +/- 0.3 log units postoperatively. The VFQ-25 composite score as well as scale scores associated with general vision, near vision, vision-related mental health, and role difficulties were significantly improved (P < .05) after successful closure of macular hole. Conversely out of the eight SF-36 health concepts, limitation in usual role activities because of emotional problems was the only one that significantly improved postoperatively. Both baseline and postoperative best-corrected visual acuity significantly correlated with most of the VFQ subscale scores before and after surgery, respectively. CONCLUSIONS: In this case-series, macular hole surgery appears to have a beneficial effect on patients' subjective perception of visual function. The use of vision-targeted health status questionnaires in conjunction with detailed clinical examination provides a more comprehensive overview of individuals' daily well-being after surgical intervention. Further controlled studies are required to confirm our findings.

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PURPOSE: To compare the incidence and the spectrum of postoperative complications detected when the intraocular pressure (IOP) is reviewed 4 to 6 hours or the day after uneventful phacoemulsification cataract extraction and intraocular lens (IOL) implantation. SETTING: Royal Free Hospital, London, United Kingdom. METHODS: The study cohort consisted of 141 patients who had uneventful phacoemulsification and IOL implantation under regional (peribulbar/topical) or general anesthesia. Postoperative evaluation of the patients was performed by an ophthalmologist using a standard form at 4 to 6 hours or 24 hours. RESULTS: The mean IOP at 4 to 6 hours and 24 hours was 22.85 mm Hg +/- 9.56 (SD) and 19.44 +/- 7.04 mm Hg, respectively. The IOP was more likely to be greater than 30 mm Hg when measured on the same day, resulting in a significantly higher intervention rate than on the first day (P =.037). The best corrected visual acuity was significantly better at 24 hours than at the same-day review (P <.001). There was no significant difference in the extent of anterior chamber activity, patient comfort, or state of the wound between the same- or next-day follow-up. All patients attended a follow-up appointment 3 weeks after surgery, had an IOP of 21 mm Hg or less, and were subsequently discharged. CONCLUSIONS: The results indicate that moderate IOP spikes (<40 mm Hg) can be left untreated if they are not associated with corneal edema or patient discomfort as they decline spontaneously. Before they are discharged, patients with compromised optic discs or predisposed to retinal or optic nerve pathology should be carefully evaluated the day after surgery to treat IOP elevations.

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AIMS: To investigate the penetration of ciprofloxacin via different modes of administration into the aqueous humour using capillary zone electrophoresis and to determine its prophylactic role in ophthalmic surgery. METHODS: A prospective study was conducted of 84 patients, divided into two groups, undergoing routine cataract surgery and intraocular lens implantation. Forty patients received 750 mg ciprofloxacin orally the evening before and on the morning of surgery 12 h apart. Forty-four patients received one drop of 0.3% topical ciprofloxacin 90 and 30 min prior to surgery. At the commencement of surgery 0.1-0.2 mL of aqueous fluid was sampled from the anterior chamber and assayed for ciprofloxacin concentration using capillary-zone electrophoresis. RESULTS: The concentration of ciprofloxacin in the group receiving topical doses was less than 0.1 micro g/mL, which is well below the minimum inhibitory concentration for cipro-floxacin inhibiting 90% (MIC90) of strains of Staphylococcus epidermidis (0.4 micro g/mL). The mean concentration of ciprofloxacin in the aqueous humour of the oral group was 0.26 micro g/mL with a standard deviation of 0.12 micro g/mL (range 0.09-0.67 micro g/mL) with only 12.5% achieving levels higher than MIC90 for S. epidermidis. CONCLUSION: The topical ciprofloxacin 0.3% as given in this study achieved poor aqueous humour concentration. Oral ciprofloxacin given in this regime should not on its own be considered adequate prophylaxis in intraocular surgery. Capillary zone electrophoresis can be used as an alternative tool to the existing high-pressure liquid chromatography methods for analysing ciprofloxacin level in the aqueous humour.

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