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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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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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