IntroductionWe aimed to investigate activities of metalloproteinases 2 (MMP-2) and MMP-9 in aqueous humour of patients with diabetes mellitus with various stages of diabetic retinopathy.Material and methodsWe included 36 samples of aqueous humour of patients suffering from diabetes mellitus, undergoing routine cataract surgery. Seven of them suffered from proliferative diabetic retinopathy (PDR), 3 had diabetic maculopathy and the remaining 26 had background or minimal background retinopathy only. Metalloproteinases 2 and MMP-9 activities in aqueous humour were measured by gelatin zymography combined with the densitometric imaging system. Total protein content in aqueous humour samples was also assessed.ResultsMetalloproteinases 2 activities were present in almost all samples of aqueous humour (32 of 36) and were 2.6-fold higher in patients who suffered from diabetic ocular complications (p < 0.0001). Activities of MMP-2 correlated well with the duration of the disease (correlation = 0.37, p = 0.03) and tended to correlate with total protein levels in aqueous humour (correlation = 0.43, p = 0.06). Metalloproteinases 9 activities were observed only in 2 of 7 patients with proliferative diabetic disease and the enzyme was absent from aqueous humour samples of patients without proliferative retinopathy.ConclusionsIncreased activities of MMP-2 in aqueous humour of patients with PDR may be related to the disease process and support the hypothesis that MMP-2 may be of particular importance in diabetic retinal neovascularization. MMP-9 may be activated at a certain disease stage only.

Purpose. To analyze the patients with secondary dislocation of CTR and IOL within 5 years from cataract surgery, to determine predisposing factors. Methods. 16 eyes of 15 patients aged 66.2 ± 6.7 (from 49 to 82) with CTR/IOL complex dislocation within 5 years from cataract surgery were compared with 26 patients aged 67.1 ± 7.2 (from 53 to 85), implanted with CTR during cataract surgery to manage zonule dehiscence and did not dislocate for at least 5 years, in respect of cause, axial length and IOL power, refraction, coexistent pathology, and trauma. Results. Axial length of the eyeball was 23.8 ± 1.3 (from 21 to 29) in the group of patients with CTR/IOL dislocation and 20.7 ± 1.2 (from 19 to 24) in patients with no dislocation present (p = 0.008). Crystalline lens dislocation was diagnosed before surgery in 13 of 16 patients with CTR/IOL complex dislocation as opposed to 7 of 26 eyes in the control group (p = 0.01). Pseudoexfoliation was present in 50% and 58% in both groups, respectively. Traumatic dislocation was present in 8 patients, none of them with CTR/IOL dislocation (p = 0.04). Conclusion. Longer axial length may contribute to the failure of the CTR to prevent in-the-bag IOL dislocation. Traumatic dislocation appears to be well fixed with the CTR.

a-adrenergic receptor antagonists are used to relax smooth muscle of the lower urinary tract, for relief of symptoms of benign prostatic hyperplasia. They cause pupil hypotony (Parssinen 2005) ABSTRACT.Purpose: To compare 2% sub-Tenon and 1% intra-cameral lidocaine for cataract surgery in relation to the incidence and severity of IFIS. Prospective randomized clinical study. Methods: From 81 eligible, we included 71 men aged from 59 to 90 years (mean 76.5 ± 6.8) undergoing routine cataract surgery and taking oral aadrenergic antagonists, for urological reasons, for more than 1 year. Following randomization 34 men, aged from 62 to 90 years (mean 77.4 ± 8.1) received sub-Tenon injection of 2.5 ml of 2% lidocaine and the remaining 37 men aged from 59 to 89 years (mean 75.2 ± 7.2) received 1% preservative free intracameral lidocaine. Outcome measures were the incidence of IFIS, severity of intra-operative pupillary constriction and iris prolapse.Results: Intra-operative floppy iris syndrome (IFIS) was noted in 3 of 34 patients (8.8%) receiving sub-Tenon lidocaine and in 18 of 37 patients (48.6%) receiving intra-cameral lidocaine (p = 0.00). Severe IFIS was observed only in 3 of 37 patients (8.1%) receiving intra-cameral lidocaine. Pupil diameter at the end of surgery was 4.37 ± 1.07 mm in the sub-Tenon lidocaine group and 4.02 ± 1.06 mm in the intra-cameral lidocaine group (p = 0.00). Iris prolapse was noted in two cases in the sub-Tenon lidocaine group and in 10 cases in the intra-cameral lidocaine group (p = 0.00). Twenty-five patients were receiving tamsulosin. The incidence of IFIS in tamsulosin subgroup was 76.9% (10 of 13 patients) in the intra-cameral lidocaine group and 16.6% (2 of 12 patients) in the sub-Tenon lidocaine group (p = 0.00). Conclusion: Sub-Tenon lidocaine reduces significantly the incidence of IFIS in patients taking oral a-adrenergic inhibitors as compared with intra-cameral lidocaine.

Background The study was conducted to analyze aqueous flare and it’s correlations in patients with Graves’ ophthalmopathy, undergoing orbital decompression, extra-ocular muscle and eyelid surgery. Prospective interventional case series. Materials and Methods 48 eyes of 27 patients(20 female and 7 male, aged 54.4±5.7), undergoing surgical treatment for GO. 18 eyes of 9 patients (aged 55.3±3.6) undergoing orbital decompression. 19 eyes of 11 patients (aged 54.7±5.6) undergoing extraocular muscle surgery and 13 eyes of 7 patients (aged 53.9±4.9) undergoing eyelid surgery and control group (34 patients aged 53.9±5.1). Laser flare analysis, and clinical assessment was performed before surgery and 1 day, 7 days and 3 months following surgery. Results Aqueous flare was significantly higher in patients with GO (14.03 ± 8.45), before intervention than in the control group (7.89 ± 3.56) (p<0.001), and correlated with Clinical Activity Score and intraocular pressure. In the patients undergoing orbital decompression, flare increased from 17.77±10.63 pc/ms to 38.32±13.56 pc/ms on the first day, and 41.31±17.19 pc/ms on the seventh day and returned to 16.01±8.58 pc/ms in 3 months. In patients undergoing extra-ocular muscle surgery flare increased from 13.05±6.50pc/ms to 23.04±11.53 pc/ms (p<0.001) on the first day, and returned to 18.02±14.09pc/ms on the seventh day. Eyelid surgery did not change flare values. Conclusions Orbital decompression disrupts blood-aqueous barrier. The integrity of blood-aqueous barrier returns to pre-operative status within three months. Extraocular muscle surgery mildly affects blood aqueous barrier integrity, and the effect subsides within seven days. Eyelid surgery does not affect blood-aqueous barrier.

Purpose To report safety and efficacy of intra‐operative injection of 2% lidocaine during small incision cataract surgery in cases of unexpected intra‐operative floppy iris syndrome. Methods 4 patients, undergoing routine cataract surgery, who were exposed to alfa‐adrenergic inhibitors, and it was not known pre‐operatively, and in whom intra‐operative floppy iris syndrome occurred unexpectedly. 2.5 ml of 2% lidocaine was injected into the sub‐Tenon space in response to intra‐operative iris prolapse and pupillary constriction. Injection was performed following hydrodissection in 3 of 4 cases and hollowing capsulorrhexis in 1 of 4 cases. The surgery was video‐taped from the beginning of the injection. Results No further iris prolapse was noted in any case, nor further pupillary constriction. Iris plane was stabilized. There were no further complications of cataract surgery. Patients were comfortable and pain free for the rest of the procedure. Conclusion Intra‐operative injection of 2% lidocaine into the sub‐Tenon space is a safe way of reversing iris floppiness and the tendency to iris prolapsed in cases of unexpected intra‐operative floppy iris syndrome. It is an alternative to other intra‐operative techniques to manage IFIS, which provides pain relief as well as iris stabilization.