In this review, we aim to highlight the advances of fundus photography for retinal screening as well as discuss the advantages, disadvantages, and implications of the various technologies that are currently available.

BackgroundAmyotrophic lateral sclerosis (ALS) is a devastating late onset neurodegenerative disorder that is characterised by the progressive loss of upper and lower motor neurons. The mechanisms underlying ALS pathogenesis are unclear; however, there is emerging evidence the innate immune system, including components of the toll-like receptor (TLR) system, may drive disease progression. For example, toll-like receptor 4 (TLR4) antagonism in a spontaneous ‘wobbler mouse’ model of ALS increased motor function, associated with a decrease in microglial activation. This study therefore aimed to extend from these findings and determine the expression and function of TLR4 signalling in hSOD1G93A mice, the most widely established preclinical model of ALS.FindingsTLR4 and one of its major endogenous ligands, high-mobility group box 1 (HMGB1), were increased during disease progression in hSOD1G93A mice, with TLR4 and HMGB1 expressed by activated microglia and astrocytes. hSOD1G93A mice lacking TLR4 showed transient improvements in hind-limb grip strength and significantly extended survival when compared to TLR4-sufficient hSOD1G93A mice.ConclusionThese results suggest that enhanced glial TLR4 signalling during disease progression contributes to end-stage ALS pathology in hSOD1G93A mice.

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The original Gillquist maneuver is done by passing the arthroscope through a portal in the patella tendon between the medial femoral condyle and posterior cruciate ligament to enter the posterior compartment. This is done blind and has been documented to result in broken cameras and damaged equipment. It is also necessary to do a notchplasty to aid the advancement of the camera in patients. In our paper, we have made modifications to allow the Gillquist maneuver to be done safely under direct visualization, with just the aid of a simple switching stick. Our technique starts with the arthroscope in the anteromedial portal. We insert a long, cannulated switching stick through the anterolateral portal and pass it between the medial femoral condyle and the posterior cruciate ligament. The switching stick, being tapered and narrow, is able to traverse the transcondylar notch with minimal trauma. Once the switching stick enters the posterior compartment, the camera and trocar are removed and the trocar sleeve is guided over the switching stick past the intercondylar notch gently. The switching stick is then replaced by the arthroscope, which is advanced through the trocar sleeve and into the posterior compartment.