The authors report two cases of spontaneous carotid-cavernous fistula that occurred during pregnancy. One patient was a 21-year-old woman whose symptoms improved and in whom disappearance of the carotid-cavernous fistula was confirmed by cerebral angiography after she aborted in the 12th week of pregnancy. The other patient was a 25-year-old woman in whom a carotid-cavernous fistula occurred at about the 28th week of pregnancy. The symptoms became aggravated 3 weeks after a normal delivery. Carotid-cavernous fistula was confirmed by cerebral angiography, and the clinical symptoms then improved. On the basis of cerebral angiographic findings, both patients were considered to have dural arteriovenous fistulas in the region of the cavernous sinus and both demonstrated spontaneous improvement.
We compared the effect of biconvex and convex-plano (posterior plano) intraocular lenses on posterior capsule opacification (PCO) following continuous curvilinear capsulorhexis (CCC) in 212 eyes. During the three years following surgery, the cumulative frequency of neodymium:YAG laser posterior capsulotomy, calculated with the Kaplan-Meier method, was significantly higher in patients in the biconvex group (32.5% by the third year) than in those in the convex-plano group (5.9% by the third year) (P < .05, Wilcoxon's test; P < .01, Cox-Mantel's test). Measured with the tracing method, the area within a 5 mm diameter central circle that developed Elschnig pearls was 2.93 +/- 4.91 mm2 in the biconvex group and 1.66 +/- 2.37 mm2 in the convex-plano group. In the study, PCO was less severe in the convex-plano group than in the biconvex group following CCC. These results are contrary to those reported previously in patients with can-opener capsulotomy.
Normal-tension glaucoma (NTG) is a heterogeneous disease characterized by retinal ganglion cell (RGC) death leading to cupping of the optic nerve head and visual field loss at normal intraocular pressure (IOP). The pathogenesis of NTG remains unclear.Here, we describe a single nucleotide mutation in exon 2 of the methyltransferase like 23 (METTL23) gene identified in a three-generation Japanese NTG family. This mutation caused METTL23 mRNA aberrant splicing, which abolished normal protein production and altered subcellular localization. Mettl23 knock-in (Mettl23 +/G & Mettl23 G/G ) and knockout (Mettl23 +/-& Mettl23 -/-) mice developed a glaucoma phenotype without elevated IOP. METTL23 is a histone arginine methyltransferase expressed in murine and macaque RGCs. However, the novel mutation reduced Mettl23 expression in RGCs of Mettl23 G/G mice, which recapitulated both clinical and biological phenotypes. Moreover, our findings demonstrated that Mettl23 catalyzed the dimethylation of H3R17 in the retina, and was required for the transcription of pS2, an estrogen receptor α target gene that was critical to RGC homeostasis through the negative regulation of NF-κB-mediated TNF-α/IL-1β feedback. These findings suggest an etiologic role of METTL23 in NTG with tissue-specific pathology.
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