Abstract. Phthiriasis palpebrarum is a rare type of eyelid infestation. In the present study, a 63-year-old woman presented with a case of phthiriasis palpebrarum, which was initially misdiagnosed as anterior blepharitis. The patient had a 2-month history of repeated episodes of itching and burning sensations and moderate pain in both eyes that were not improved by antibiotic and corticosteroid eye drops. Slit lamp examination revealed lice and nits anchored to the eyelashes. All eyelashes were removed from the base along with lice and nits. The patient recovered fully within 2 weeks with no further management, and no evidence of lice or nits was found at the follow up. In conclusion, the findings of the present study suggests that patients presenting with itching of the eyelids and with clinical findings resembling seborrhea accumulation on the eyelashes should be carefully examined by prolonged observation with a slit lamp.

The aim of the present study was to observe the histopathological changes of immunoglobulin G4-related orbital diseases (IgG4-RODs), summarize the clinical manifestations and imaging features of the IgG4-RODs of the eyelids and explore the early diagnosis of IgG4-RODs. Between June 2011 and May 2015, 23 patients with non-specific orbital inflammation in the Department of Ophthalmology at the First Central Hospital of Tianjin were recruited. The serum IgG4 titer in 9 patients ranged from 4.58 to 46.70 g/l (reference value, 0.03-2.01 g/l), with an average value of 21.93±2.18 g/l. Notably, the degree of increase in the 9 patients with IgG4-RODs was different, but all were >1.35 g/l. A total of 6 cases of infraorbital nerve thickening were observed. In addition, there were 3 cases of extraocular muscle thickening and 1 patient with IgG4-ROD had an orbital tissue lesion extending along the inferior temporal septum to the left pterygopalatine fossa, with left sacral fissure widening and involvement of the left maxillary sinus. The study revealed that the thickening of the inferior orbital nerve may be a characteristic of IgG4-ROD. Therefore, on the basis of biopsy and serological examination in the clinic, early diagnosis can be combined with imaging examination, clinical manifestation and laboratory examination, so as to reduce misdiagnosis and missed diagnosis.

Early elevated intraocular pressure (IOP) following pars plana vitrectomy is a common complication of vitreoretinal surgery and severe pressure elevation may result in visual loss. To investigate the mechanism of IOP elevation following pars plana vitrectomy, a retrospective review of 119 patients (132 eyes) who had undergone vitreoretinal surgery was performed. Ultrasound biomicroscopy (UBM) was used to observe the changes in the structure of the anterior segment following vitrectomy and to compare various parameters pre- and postsurgery. The UBM examination revealed inflammation within the anterior chamber and hyphema with increased IOP. In certain patients, the iris had adhered to the trabecular meshwork and the anterior chamber angle was closed. Cyclodialysis involving the pars plicata and iris was also observed. Furthermore, silicone oil emulsification in the anterior chamber angle and posterior chamber presurgery were noted in certain cases. Edema and forward rotation of the ciliary body resulted in the closure of the anterior chamber angle. The measured parameters indicated that the anterior chamber became shallower and that the anterior chamber angle was narrowed in phakic eyes with elevated IOP. Eyes with elevated IOP and intraocular lenses were not observed to be different from phakic eyes with elevated IOP. This may be due to the fact that an eye with an intraocular lens is thinner than a phakic eye. This study suggests that UBM examination is useful for investigating the pathogenesis of elevated IOP following vitrectomy, and provides a theoretical basis.

Images in Infectious Diseases FIGURE 1: Computed tomography scan showing apparent destruction at the anterior superior corner of the L4 vertebra (Pedro Pons' sign) accompanied by prominent osteosclerosis and osteophytes resembling a parrot's beak.

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Background: Cardiovascular diseases may originate in childhood. Biomarkers identifying individuals with increased risk for disease are needed to support early detection and to optimise prevention strategies. Methods: In this prospective study, by applying a machine learning to high throughput NMR-based metabolomics data, we identified circulating childhood metabolic predictors of adult cardiovascular disease risk (MetS score) in a cohort of 396 females, followed from childhood (mean age 11¢2 years) to early adulthood (mean age 18¢1 years). The results obtained from the discovery cohort were validated in a large longitudinal birth cohort of females and males followed from puberty to adulthood (n = 2664) and in four cross-sectional data sets (n = 6341). Findings: The identified childhood metabolic signature included three circulating biomarkers, glycoprotein acetyls (GlycA), large high-density lipoprotein phospholipids (L-HDL-PL), and the ratio of apolipoprotein B to apolipoprotein A-1 (ApoB/ApoA) that were associated with increased cardio-metabolic risk in early adulthood (AUC = 0¢641-0¢802, all p<0¢01). These associations were confirmed in all validation cohorts with similar effect estimates both in females (AUC = 0¢667-0¢905, all p<0¢01) and males (AUC = 0¢734-0¢889, all p<0¢01) as well as in elderly patients with and without type 2 diabetes (AUC = 0¢517-0¢700, all p<0¢01). We subsequently applied random intercept cross-lagged panel model analysis, which suggested bidirectional causal relationship between metabolic biomarkers and cardio-metabolic risk score from childhood to early adulthood. Interpretation: These results provide evidence for the utility of a circulating metabolomics panel to identify children and adolescents at risk for future cardiovascular disease, to whom preventive measures and followup could be indicated.

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