Morphological effects of ArF excimer laser irradiation on enamel and dentin

BACKGROUND AND OBJECTIVE

The aim of this investigation to determine the range of morphological and ablative effects that can be achieved on dental enamel and dentin using ArF excimer laser irradiation at a wavelength of 193nm.

STUDY DESIGN/MATERIALS AND METHODS

Caries-free coronal enamel and dentin surfaces of 20 extracted human teeth were subjected to irradiation at 193nm using a Lamda-Physik model EMG 103 MSC and ArF fill. Morphology of cavity floors and walls were assessed by light microscopy and SEM.

RESULTS

Morphological surface effects and ablation could be controlled effectively and reliably by choice of parameter combination, allowing the operator to achieve either a smooth, flat, or increasingly rough surface with differing degrees of selective ablation. No signs of thermal damage were apparent.

CONCLUSION

Excimer laser irradiation at 193nm provided clinically useful cavity preparations and surface morphological effects.

Activation barriers to structural transition determine deposition rates of Alzheimer's disease a beta amyloid

Brain amyloid composed of the approximately 40-amino-acid human beta-amyloid peptide A beta is integral to Alzheimer's disease pathology. To probe the importance of a conformational transition in Abeta during amyloid growth, we synthesized and examined the solution conformation and amyloid deposition activity of A beta congeners designed to have similar solution structures but to vary substantially in their barriers to conformational transition. Although all these peptides adopt similar solution conformations, a covalently restricted Abeta congener designed to have a very high barrier to conformational rearrangement was inactive, while a peptide designed to have a reduced barrier to conformational transition displayed an enhanced deposition rate relative to wild-type A beta. The hyperactive peptide, which is linked to a heritable A beta amyloidosis characterized by massive amyloid deposition at an early age, displayed a reduced activation barrier to deposition consistent with a larger difference in activation entropy than in activation enthalpy relative to wild-type A beta. These results suggest that in Alzheimer's disease, as in the prion diseases, a conformational transition in the depositing peptide is essential for the conversion of soluble monomer to insoluble amyloid, and alterations in the activation barrier to this transition affect amyloidogenicity and directly contribute to human disease.

The Alzheimer's peptide a beta adopts a collapsed coil structure in water

The self-assembly of the soluble peptide Abeta into Alzheimer's disease amyloid is believed to involve a conformational change. Hence the solution conformation of Abeta is of significant interest. In contrast to studies in other solvents, in water Abeta is collapsed into a compact series of loops, strands, and turns and has no alpha-helical or beta-sheet structure. Conformational stabilization is primarily attributed to van der Waals and electrostatic forces. A large conspicuous uninterrupted hydrophobic patch covers approximately 25% of the surface. The compact coil structure appears meta-stable, and because fibrillization leads to formation of intermolecular beta-sheet secondary structure, a global conformational rearrangement is highly likely. A molecular hypothesis for amyloidosis includes at least two primary driving forces, changes in solvation thermodynamics during formation of amyloid deposits and relief of internal conformational stress within the soluble precursor during formation of lower-energy amyloid fibrils.

Alzheimer's disease amyloid propagation by a template-dependent dock-lock mechanism

Amyloid plaques composed of the peptide Abeta are an integral part of Alzheimer's disease (AD) pathogenesis. We have modeled the process of amyloid plaque growth by monitoring the deposition of soluble Abeta onto amyloid in AD brain tissue or synthetic amyloid fibrils and show that it is mediated by two distinct kinetic processes. In the first phase, "dock", Abeta addition to the amyloid template is fully reversible (dissociation t(1/2) approximately 10 min), while in the second phase, "lock", the deposited peptide becomes irreversibly associated (dissociation t(1/2) >> 1000 min) with the template in a time-dependent manner. The most recently deposited peptide dissociates first while Abeta previously deposited becomes irreversibly "locked" onto the template. Thus, the transition from monomer to neurotoxic amyloid is mediated by interaction with the template, a mechanism that has also been proposed for the prion diseases. Interestingly, two Abeta peptides bearing primary sequence alterations implicated in heritable Abeta amyloidoses displayed faster lock-phase kinetics than wild-type Abeta. Inhibiting the initial weak docking interaction between depositing Abeta and the template is a viable therapeutic target to prevent the critical conformational transition in the conversion of Abeta((solution)) to Abeta((amyloid)) and thus prevent stable amyloid accumulation. While thermodynamics suggest that inhibiting amyloid assembly would be difficult, the present study illustrates that the protein misfolding diseases are kinetically vulnerable to intervention.

APP carboxyl-terminal fragment without or with abeta domain equally induces cytotoxicity in differentiated PC12 cells and cortical neurons

Mutations in the beta-amyloid precursor protein (APP) gene cause familial Alzheimer's disease (AD). Although amyloid beta peptide (Abeta) is the principal constituent of senile plaques in AD, other cleavage products of APP are also implicated in playing a role in the pathogenesis of AD. C-terminal fragments of APP (APP-CTs), that contain complete Abeta sequence, are found in neuritic plaques, neurofibrillary tangles and the cytosol of lymphoblastoid cells obtained from AD patients. Our previous report demonstrated that APP-CT105 causes death of differentiated PC12 cells and cultured rat cortical neurons (Kim and Suh [1996] J. Neurochem. 67:1172-1182) and induces strong inward currents in Xenopus oocyte (Fraser et al., [1996] J. Neurochem. 66:2034-2040). In the present study, to investigate which domain of APP-CT105 is responsible for the neurotoxicity, we have made deletion mutants of APP-CT105 without Abeta and transmembrane domain (TM) or without NPTY domain, a putative endocytosis signaling sequence, using the PCR-amplified strategy and the recombinant GST-fusion protein strategy. The effect on cell survival of the deletion mutants of APP-CT105 (8 microM) was then determined by the LDH and MTT assay. We found that C-terminal fragment without NPTY significantly causes cell death in NGF-differentiated PC12 cells and cultured rat cortical neurons. This finding suggests that NPTY may not play an important role in APP-CT105 mediated neurotoxicity. We found, however, that C-terminal fragment without Abeta and TM significantly induces neuronal cell death. Our results suggest that in addition to Abeta, C-terminal fragment of APP without Abeta and TM domain itself may also participate in the neuronal degeneration in AD.

Functional role of caspase-1 and caspase-3 in an ALS transgenic mouse model

Mutations in the copper/zinc superoxide dismutase (SOD1) gene produce an animal model of familial amyotrophic lateral sclerosis (ALS), a fatal neurodegenerative disorder. To test a new therapeutic strategy for ALS, we examined the effect of caspase inhibition in transgenic mice expressing mutant human SOD1 with a substitution of glycine to alanine in position 93 (mSOD1(G93A)). Intracerebroventricular administration of zVAD-fmk, a broad caspase inhibitor, delays disease onset and mortality. Moreover, zVAD-fmk inhibits caspase-1 activity as well as caspase-1 and caspase-3 mRNA up-regulation, providing evidence for a non-cell-autonomous pathway regulating caspase expression. Caspases play an instrumental role in neurodegeneration in transgenic mSOD1(G93A) mice, which suggests that caspase inhibition may have a protective role in ALS.

Cytotoxic triterpenes from Crataegus pinnatifida

Bioassay-guided fractionation of Crataegus pinnatifida (Rosaceae) gave two cytotoxic ursane-type triterpenes which were identified as uvaol (1) and ursolic acid (2) by physicochemical and spectroscopic methods. 3-Oxo-ursolic acid (3) was synthesized from ursolic acid (2) by Jones method. The cytotoxic activities of these compounds were tested against murine L1210 and human cancer cell lines (A549, SK-OV-3, SK-MEL-2, XF498, and HCT15) in vitro. Compounds 1 and 2 showed moderate cytotoxicities against L1210, whereas they showed weak activities against human cancer cell lines. However, compound 3 exhibited potent cytotoxic activities both in murine and in human cancer cell lines.

Mutation analysis of PTEN/MMAC1 in acute myeloid leukemia

Recently, a putative tumor suppressor gene, PTEN/MMAC1, has been identified at chromosome 10q23.3, which encodes a 403 amino acid dual-specificity phosphatase containing a region of homology to tensin and auxillin. Somatic mutations of the PTEN/MMAC1 gene have been identified in a number of cancer cell lines and primary cancers. Mutations in PTEN/MMAC1 are most frequently found in advanced cancers. To evaluate the role of the PTEN/MMAC1 gene in leukemia, bone marrow and/or peripheral blood from 62 acute myeloid leukemia (AML) patients, 5 hemopoietic cell lines (HL60, U937, Raji, KG-1, K562), and 30 normal controls were analyzed. The results showed aberrant PTEN/MMAC1 transcripts in 15 of the 62 (24%) AML patients, 4 of the 5 cell lines (80%), and 4 of the 30 (13%) normal controls. As in our previous study of TSG101, the abnormal transcripts may result from aberrant RNA splicing as evidenced by the presence of both these aberrant transcripts and normal full length transcripts in all specimens examined. Loss of heterozygosity (LOH) analysis and PCR-SSCP of the entire coding region showed that none of the AML cases had LOH or mutation. Only one frameshift mutation at codon 130 (insertion of CCCG) with premature termination of coding sequence was observed in the U937 cell line. Our results indicate that the PTEN/MMAC1 gene may play a role in a small percentage of AML, but its significance needs to be further evaluated.

Congenital anomalies in patients with Duane retraction syndrome and their relatives

PURPOSE

Although the high incidence of skeletal, neural, and other ocular problems has been identified in previous reports of large cohorts of patients with Duane syndrome, there has not been any documentation of anomalies in close relatives. Patients with Duane syndrome have a greater than 50% incidence of associated abnormalities that include deafness, other ocular anomalies, cranial nerve palsies, and skeletal abnormalities. This study was undertaken to review the experience of our strabismus service with patients who have Duane retraction syndrome (DRS) and to delineate the associated anomalies in them and their first-degree relatives.

METHODS

A prospective study of all patients with Duane syndrome who were seen at the strabismus service at Moorfields Eye Hospital has been ongoing for the last 4 years. All patients were assessed for the presence of ophthalmologic features of DRS and then referred to the pediatric service for a physical and neurologic examination. First-degree relatives were also examined, and a family pedigree was generated.

RESULTS

We have evaluated 68 patients with DRS, of which 60.2% were female patients. The left eye was involved at a ratio of 4:1 in unilateral cases. The number of bilateral cases was 57.3%. Among the patients with DRS, 46% had first-degree relatives with associated abnormalities.

CONCLUSIONS

The high incidence of associated anomalies in patients and first-degree relatives may suggest that a common genetic defect is responsible. This has to be confirmed with molecular genetic studies, which were not performed on these families because of a lack of available resources. However, our findings may indicate that the inheritance of Duane syndrome is much higher than the 10% previously reported, if any congenital abnormality is accepted as DRS associated. Children with Duane syndrome may benefit from a full medical assessment, in view of the frequency of other abnormalities, and so may their siblings.

Antifungal activity of magnolol and honokiol

Two neolignan compounds, magnolol (5,5'-diallyl-2,2'-dihydroxybiphenyl, 1) and honokiol (5,5'-diallyl-2,4'-dihydroxybiphenyl, 2), were isolated from the stem bark of Magnolia obovata and evaluated for antifungal activity against various human pathogenic fungi. Compound 1 and 2 showed significant inhibitory activities against Trichophyton mentagrophytes, Microsporium gypseum, Epidermophyton floccosum, Aspergillus niger, Cryptococcus neoformans, and Candida albicans with minimum inhibitory concentrations (MIC) in a range of 25-100 microg/ml. Therefore, compound 1 and 2 could be used as lead compounds for the development of novel antifungal agents.

Roles of A beta and carboxyl terminal peptide fragments of amyloid precursor protein in Alzheimer disease

Several lines of evidence indicate that A beta may play an important role in the pathogenesis of AD. However, there are several discrepancies between the production of A beta and the development of the disease. Thus, A beta may not be the sole active fragment of beta-amyloid precursor protein (betaAPP) in the neurotoxicity assiciated with AD. We focused on the amyloidegenic carboxyl terminal fragments of betaAPP containing the full length of A beta (CT105). We synthesized a recombinant carboxyl-terminal 105 amino acid fragment of betaAPP and examined the effects of CT105 and A beta on cultured neurons, Ca++ uptake into rat brain microsomes, Na+-Ca++ exchange activity, ion channel forming activity in lipid bilayers and passive avoidance performance of mice. Our results suggest that the cytotoxic and channel inducing effects of CT105 are much more potent than that of A beta and toxic mechanisms of CT105 are different from those of A beta. Taken together, these lines of evidence postulate that CT is an alternative toxic element important in the generation of the symptoms common to AD.

Mutation analysis of PTEN/MMAC 1 in sporadic thyroid tumors

Recently, a putative tumor suppressor gene, PTEN/MMAC1, has been identified at chromosome 10q23.3. This gene encodes a 403 amino acid dual specificity phosphatase containing a region of homology to tensin and auxillin. Somatic mutations of the PTEN/MMAC1 gene have been found in a number of cancer cell lines and primary cancers. Cowden disease, an autosomal dominant harmartoma syndrome associated with thyroid and breast tumors, has been found to be associated with mutations of PTEN/MMAC1 gene. To evaluate the role of the PTEN/MMAC1 gene in sporadic thyroid tumors, we studied 17 sporadic thyroid tumors, of which 12 were papillary thyroid carcinomas, 1 was follicular thyroid carcinoma, 1 was medullary thyroid carcinoma and 3 were thyroid adenomas. Direct sequencing of PCR-amplified products was performed for all nine exons of PTEN/MMAC1. No mutations of PTEN/MMAC1 gene were observed in any of the sporadic thyroid tumors. Our results indicate that the PTEN/MMAC1 gene may not play a major role in sporadic thyroid tumors.

Selectively 2H-labeled Glu/Asp: application to pKa measurements in Abeta amyloid peptides

Human Abeta peptides have been linked to Alzheimer's disease, and it is hypothesized that formation of amyloid as well as neurotoxicity are important events in the etiology of the disease. Previous studies have shown that the soluble precursor to Alzheimer's amyloid undergoes a pH-dependent folding transition as the self-assembly activity appears, and based upon inter-residue proximities, it was suspected that stabilization of the soluble form might rely upon formation of an intramolecular salt-bridge. However, pKa studies on a model 17-residue Abeta fragment supported an electrostatic model where a solvation imperative for charged side-chain atoms drives the folding process. To explore this model in an active 26-residue fragment as well as the full-length 40-residue Abeta peptide, pKa measurements were performed via 1H and 2H NMR. To overcome issues related to sensitivity and spin system degeneracy, specifically deuterated allyl protected-Fmoc amino acids were synthesized for incorporation into a series of peptides, and a high sensitivity 2H observe NMR probe was constructed.

What is the role of botulinum toxin in the treatment of dysthyroid strabismus?

BACKGROUND

Botulinum toxin A has been used in the treatment of dysthyroid strabismus primarily as a temporary measure during the active phase of the disease. We report on our experience with 65 patients.

METHOD

We review the records of 65 patients with dysthyroid strabismus who were treated with botulinum toxin A at Moorfields Eye Hospital between 1984 and 1996.

CONCLUSIONS

Patients with a short duration of relatively mild dysthyroid strabismus have a chance of long-term benefit with botulinum toxin A. There is little use for botulinum toxin A in cases of severe dysthyroid disease.

Role of botulinum toxin A in surgically overcorrected exotropia

PURPOSE

The purpose of this study was to define the role of botulinum toxin type A (BTXA) in surgically overcorrected exotropia.

METHODS

A retrospective review was performed using the BTXA clinic database of more than 3500 patients to identify patients with a consecutive esotropia.

RESULTS

Sixty patients met the inclusion criteria; the patients' ages ranged from 5 to 80 years. Before toxin treatment, an average of 1.8 operations had been performed per patient. The mean distance deviation was 17 PD base out and near deviation was 18 PD base out. The time from the last operation to an injection of BTXA averaged 28.3 months. We divided our patient population into 2 groups: those with fusion potential and those with no expected fusion potential. Of the 36 patients with fusion potential, 15 patients achieved and maintained good ocular alignment and resolution of their diplopia with an injection of BTXA. In the 24 patients with no expected fusion potential, 4 patients (17%) achieved and maintained good alignment with an injection of BTXA. Although they were not cured, 10 additional patients chose to have repeated BTXA injections to maintain their ocular alignment, whereas only 2 patients required occlusive methods to eradicate intractable diplopia. Five patients had additional surgery, of which 3 patients obtained a functional result.

CONCLUSIONS

BTXA has a role in surgically overcorrected exotropia for patients in whom a functional result may be obtained. BTXA is of less value for patients with poor binocular function. It has proved especially useful as a treatment given only once for 42% of patients who could regain high-quality stereopsis. The safety and ease of administration of this treatment add to its merit.

Deposition of monomeric, not oligomeric, Abeta mediates growth of Alzheimer's disease amyloid plaques in human brain preparations

Senile plaques composed of the peptide Abeta contribute to the pathogenesis of Alzheimer's disease (AD), and mechanisms underlying their formation and growth may be exploitable as therapeutic targets. To examine the process of amyloid plaque growth in human brain, we have utilized size exclusion chromatography (SEC), translational diffusion measured by NMR, and in vitro models of Abeta amyloid growth to identify the oligomerization state of Abeta that is competent to add onto an existing amyloid deposit. SEC of radiolabeled and unlabeled Abeta over a concentration range of 10(-)(10)-10(-)(4) M demonstrated that the freshly dissolved peptide eluted as a single low molecular weight species, consistent with monomer or dimer. This low molecular weight Abeta species isolated by SEC was competent to deposit onto preexisting amyloid in preparations of AD cortex, with first-order kinetic dependence on soluble Abeta concentration, establishing that solution-phase oligomerization is not rate limiting. Translational diffusion measurements of the low molecular weight Abeta fraction demonstrate that the form of the peptide active in plaque deposition is a monomer. In deliberately aged (>6 weeks) Abeta solutions, a high molecular weight (>100 000 M(r)) species was detectable in the SEC column void. In contrast to the active monomer, assembled Abeta isolated from the column showed little or no focal association with AD tissue. These studies establish that, at least in vitro, Abeta exists as a monomer at physiological concentrations and that deposition of monomers, rather than of oligomeric Abeta assemblies, mediates the growth of existing amyloid in human brain preparations.

Two-phase methanization of food wastes in pilot scale

A 5 ton/d pilot scale two-phase anaerobic digester was constructed and tested to treat Korean food wastes in Anyang city near Seoul. The easily degradable presorted food waste was efficiently treated in the two-phase anaerobic digestion process. The waste contained in plastic bags was shredded and then screened for the removal of inert materials such as fabrics and plastics, and subsequently put into the two-stage reactors. Heavy and light inerts such as bones, shells, spoons, and plastic pieces were again removed by gravity differences. The residual organic component was effectively hydrolyzed and acidified in the first reactor with 5 d space time at pH of about 6.5. The second, methanization reactor converted the acids into methane with pH between 7.4 and 7.8. The space time for the second reactor was 15 d. The effluent from the second reactor was recycled to the first reactor to provide alkalinities. The process showed stable steady-state operation with the maximum organic loading rate of 7.9 kg volatile solid (VS)/m3/d and the volatile solid reduction efficiency of about 70%. The total of 3.6 tons presorted MSW containing 2.9 tons of food organic was treated to produce about 230 m3 of biogas with 70% (v/v) of methane and 80 kg of humus. This process is extended to full-scale treating 15 tons of food waste a day in Euiwang city and the produced biogas is utilized for the heating/cooling of adjacent buildings.

Spag4, a novel sperm protein, binds outer dense-fiber protein Odf1 and localizes to microtubules of manchette and axoneme

Outer dense fibers are structures unique to the sperm tail. No definite function for these fibers has been found, but they may play a role in motility and provide elastic recoil. Their composition had been described before, but only two of the fiber proteins, Odf1 and Odf2, are cloned. We cloned Odf2 by virtue of its functional and specific interaction with Odf1, which, we show, is mediated by a leucine zipper. Further work demonstrated that the 84-kDa Odf2 protein localizes to both the cortex and the medulla of the fibers, whereas the 27-kDa Odf1 protein is present only in the medulla. Here we report the cloning and characterization of a new Odf1-interacting protein, Spag4. Spag4 mRNA is spermatid specific, and the 49-kDa Spag4 protein complexes specifically with Odf1, but not Odf2, mediated by a leucine zipper. It also self-associates. In contrast to Odf1 and Odf2, Spag4 protein localizes to two microtubule-containing spermatid structures. Spag4 is detectable in the transient manchette and it is associated with the axoneme in elongating spermatids and epididymal sperm. Our data suggest a role for Spag4 in protein localization to two major sperm tail structures.

Botulinum toxin in childhood strabismus

The use of botulinum toxin A (BTXA) in childhood strabismus is still a matter of debate. This study investigates the indications for and outcome of BTXA therapy in children at our institution. From 1985 to 1995, 237 children up to and including 16 years of age were treated with BTXA for strabismus. We undertook a retrospective study of 163 (69%) children from this group. Factors considered were age; anaesthesia; number of, indication for and outcome of injections; complications and follow-up. There were three major indications for the use of BTXA in children: firstly to improve binocular function, secondly as a post-operative diplopia test or for cosmetic reasons, and thirdly in the investigation or treatment of paralytic and restrictive strabismus. In the first group (54 children), BTXA produced improved binocular function in 54% of all patients treated and in 49% of those with a minimum follow-up of 12 months. In the second group (82 children), 88% showed informative post-operative diplopia tests and 44% had more than one injection to maintain improved cosmetic alignment. The third group comprised 27 children with a range of diagnoses, including 1 third nerve paresis, 12 unilateral or bilateral sixth nerve pareses, 7 unilateral or bilateral Duane's syndromes, 5 lost or fibrosed muscles and 2 others. This group had a range of outcomes which are discussed in the text. BTXA is useful in the treatment of a select group of children with strabismus. If there is evidence of threatened or recently lost binocularity, or risk of creating or worsening diplopia after surgery, it is a useful therapeutic tool. In children with strabismus of unusual cause it has diagnostic value.

The role of immunophilins in mutant superoxide dismutase-1linked familial amyotrophic lateral sclerosis

It has been reported that expression of familial amyotrophic lateral sclerosis (FALS)-associated mutant Cu/Zn superoxide dismutase-1 (SOD) induces apoptosis of neuronal cells in culture associated with an increase in reactive oxygen species. SOD recently has been shown to prevent calcineurin inactivation, initiating the present investigations examining the role of calcineurin in mutant SOD-induced cell death. Wild-type or mutant SOD was expressed in neuronal cells by infection with replication-deficient adenoviruses. PC12 cells overexpressing human wild-type SOD exhibited higher calcineurin activity than cells expressing FALS-related mutant SOD (SODV148G); however, cells expressing SODV148G had calcineurin activity equal to mock-infected cells, suggesting that cell death induced by mutant SOD was not related to a decrease in calcineurin activity. Calcineurin antagonists such as cyclosporin A and FK506, as well as nonimmunosuppressant analogs of cyclosporin A, significantly enhanced SODV148G- and SODA4V-induced cell death. Because both groups of drugs inhibit the rotamase activity of cyclophilins (CyP), but only the immunosuppressant analogs inhibit calcineurin activity, these data suggest that rotamase inhibition underlies the enhanced cell death after SODV148G expression. The importance of rotamase activity in mutant SOD-mediated apoptosis was supported by experiments showing that overexpressed wild-type cyclophilin A (CyPA), but not CyPA with a rotamase active site point mutation, protected cells from death after SODV148G expression. These data suggest that mutant SOD produces a greater need for rotamase and, also, highlights possible new therapeutic strategies in FALS.

Residual structure in the Alzheimer's disease peptide: probing the origin of a central hydrophobic cluster

BACKGROUND

. Structure-function studies on the Alzheimer's disease peptide sh w that a central hydrophobic cluster - Abeta(17-21), LVFFA - is a prominent structural feature linked to plaque competence. The origin and stability of this cluster was probed in a 17-residue fragment which includes flanking residues that potentially help stabilize the cluster.

RESULTS

After residue substitution, the measurement of pKas, amide exchange rates and other NMR data show that any coulombic interactions between His14 and Glu22 are not required for the stability of the central hydrophobic cluster. In contrast, a single substitution within the cluster disrupts its integrity and causes the largest pKa shift for flanking residues, while increasing the solvent accessibility of the backbone.

CONCLUSIONS

The integrity of the structurally dominant cluster relies primarily upon local hydrophobic interactions, rather than on interactions between the sidechains of charged flanking residues. Moreover, the conformational disposition of the cluster affects the pKas of flanking residues, underscoring its structural dominance.

Ocular motility disturbances after surgery for retinal detachment

PURPOSE

Relatively little has been published on the management of motility problems after surgery for retinal detachment. We report a large series with the aim of describing clinical features, management, and outcome.

METHODS

The charts of 68 of 86 consecutive patients referred to one of us between 1989 and 1995 were retrieved and analyzed. Sixty-two had unilateral and 6 bilateral surgery for retinal detachment. In 45 cases the macula was detached at surgery. The visual acuity of the affected eyes ranged from hand motions to 6/6. Sensory testing suggested potential binocular function in 39.7%. Fifty-nine patients had combined vertical and horizontal strabismus, 8 horizontal alone, and 1 vertical only. The average vertical deviation measured 10.2 PD and the average horizontal 19 PD.

RESULTS

Twelve patients underwent strabismus surgery, 26 were treated with botulinum toxin, 21 were managed conservatively with prisms or occlusion, and 8 refused or did not require treatment. Forty-seven percent of the group regained binocularity (20.5% cured with surgery or botulinum toxin, 26.5% controlled with prisms or intermittent injection with botulinum toxin). A total of 20.7% gained improvement in appearance, 19.1% were managed with permanent occlusion, and 13.2% either refused or did not require treatment.

CONCLUSION

Macula off retinal detachment, poor visual acuity plus or minus distortion, and multiple procedures for retinal reattachment are associated with a poor prognosis for restoration of binocular vision and a good outcome. In our hands, botulinum toxin treatment is the method of choice, with surgery used in selected cases.