Type 1 diabetes mellitus--characterized by the permanent destruction of insulin-secreting β-cells--is responsive to cell-based treatments that replace lost β-cell populations. The current gold standard of pancreas transplantation provides only temporary independence from exogenous insulin and is fraught with complications, including increased mortality. Stem cells offer a number of theoretical advantages over current therapies. Our review will focus on the development of treatments involving tissue stem cells from bone marrow, liver and pancreatic cells, as well as the potential use of embryonic and induced pluripotent stem cells for Type 1 diabetes therapy. While the body of research involving stem cells is at once promising and inconsistent, bone marrow-derived mesenchymal stem cell transplantation seems to offer the most compelling evidence of efficacy. These cells have been demonstrated to increase endogenous insulin production, while partially mitigating the autoimmune destruction of newly formed β-cells. However, recently successful experiments involving induced pluripotent stem cells could quickly move them into the foreground of therapeutic research. We address the limitations encountered by present research and look toward the future of stem cell treatments for Type 1 diabetes.

Radiotherapy is a safe and effective treatment for active TED in appropriately selected patients.

Purpose: To report initial results using a native 240 frames per second smartphone camera for 2-dimensional videographic analysis of eyelid dynamics during spontaneous blinking. Methods: Spontaneous blinking was prospectively recorded in volunteers using a smartphone camera recording at 240 frames per second in 720p. A standardized recording setup was used in which the smartphone was mounted on a tripod stand at 0.5 m in the Frankfort horizontal plane. Subjects viewed a nature documentary video in primary gaze while their spontaneous blinking was recorded for 3 minutes. Exclusion criteria included known eyelid malposition or ocular surface pathology, including dry eye syndrome, contact lens use, prior eyelid or intraocular surgery, prior periocular trauma, or craniofacial abnormality. Primary outcome measures were spontaneous interblink interval, blink rate in blinks per minute, percentage of incomplete blinks, and blink velocity. Results: The authors studied 10 subjects, 5 men and 5 women. Average age was 34 (range 19–58). Mean interblink interval was found to be 7.4 seconds (SD: 5.2, range: 1.9–17.6), corresponding to a mean blink rate of 13 blinks per minute (SD: 7.8, range: 3.4–32.0). Mean percentage of incomplete blinks was 49.8% (SD: 33.3, range: 0–100). Mean blink closure velocity was 93 mm/seconds (SD: 31, range: 40–160). These numbers are consistent with previously published results of spontaneous eyelid blink parameters. Conclusions: This study demonstrates that 240 frames per second videography native to modern smartphone cameras captures anatomic detail and blink dynamics with sufficient resolution and clarity to provide objective clinical information about spontaneous eyelid blink rate, dynamics, and function.

Background: Invasive fungal sinusitis carries high morbidity and mortality and often poses a diagnostic challenge. Orbital apex syndrome (OAS) is not an uncommon presentation in the setting of invasive fungal sinusitis. Delays in diagnosis and appropriate treatment can result in permanent visual dysfunction and, potentially, death. We present 2 cases of OAS secondary to invasive sinus aspergillosis, detailing the diagnostic process, treatment, and outcome for both patients. Subsequently, we present a review of the literature and combined analysis of our 2 patients plus 71 cases from previously published reports. Methods: Literature review was performed to identify demographic, diagnostic, clinical, and treatment data of patients with OAS caused by Aspergillus species. Results: The review resulted in 52 included articles with 71 patients, plus our 2 reported patients, leading to a total of 73 subjects included in the analysis. The average age of patients at presentation was 59.9 years. A combination of visual disturbance and pain (headache and/or periocular pain) was the most common presentation reported (46 cases; 63%). Diabetes mellitus was reported in 15 cases (21%), with more than half specifically noted to have poorly controlled diabetes. After diabetes, the second most common cause of immunocompromise was chronic steroid use (n = 13; 18%). Empiric antifungal treatment was started in 10 patients (14%), while 25 patients (34%) were first treated with systemic steroids due to a concern for an inflammatory etiology. Time to diagnosis from initial presentation was on average 7.4 weeks (range of 0.3-40 weeks). Approximately 78% of the cases (57 of 73) had biopsies with histology that confirmed Aspergillus fungal morphology, and 30/73 (41%) had diagnostic fungal cultures. The majority of the cases received monotherapy with intravenous (IV) amphotericin B (36 patients; 49%) and IV voriconazole (19 patients; 26%), with a combination of the 2 or more antifungal agents being used in 11 patients (15%). Forty patients (55%) showed signs of clinical improvement with treatment, while 33 (45%) patients did not experience any improvement or continued to deteriorate, and 23 (32%) died in the course of their reported follow-up. Conclusions: The present cases illustrate well the challenge in the diagnosis and treatment of OAS due to invasive sinus aspergillosis. Our review and analysis of 73 cases support the notion that a high index of suspicion leading to early biopsy with histology and fungal culture is paramount for diagnosis. Early empiric antifungal treatment and debridement can potentially reduce morbidity and mortality.

Blepharoptosis is common following ocular surgery and can occur through multiple mechanisms. Certain individuals are at a higher risk for postoperative blepharoptosis, but all surgeons and patients undergoing ocular surgery should understand this risk when providing informed consent. Operative techniques can be adjusted to decrease rates of postoperative blepharoptosis.