Publications by authors named "Ian B Marsh"

24 Publications

  • Page 1 of 1

Rectus Muscle Resection for Vertical Strabismus in Thyroid Eye Disease.

Strabismus 2018 06 27;26(2):71-76. Epub 2018 Feb 27.

c Ophthalmology Department , Norfolk and Norwich University Hospitals NHS Foundation Trust , Norwich, Norfolk , UK.

Purpose: Rectus muscle resection in thyroid eye disease (TED) is generally avoided due to the risk of worsening restriction or reactivating inflammation. However, for some patients with large-angle strabismus or diplopia in primary gaze despite maximum recession surgery, rectus muscle resection may be beneficial. We report our surgical experience with rectus muscle resection in the management of vertical strabismus associated with TED.

Methods: Retrospective review of eight patients with TED and vertical diplopia who underwent vertical rectus muscle resection by a single surgeon (IBM) at a tertiary referral centre in Liverpool, UK, from 2001 to 2013. The goal of surgery was elimination of diplopia in primary and reading position. Vertical deviations were measured in prism dioptres () before and after surgery at one month, four months and final visit by prism alternate cover testing at ⅓ m and 6 m.

Results: The mean ± standard deviation vertical deviation for near and distance reduced significantly from 14.2 ± 8.4 and 15.8 ± 8.8 pre-operatively to 5.7 ± 4.9 and 6.7 ± 7 at the four-month visit, respectively (p< 0.05). At the four-month follow-up, five (62.5%) patients achieved binocular single vision in primary and reading position with either no prisms or prisms less than 5. Further recession surgery, Harada-Ito procedure, or lateral rectus resection were necessary in four (50%) patients with persistent diplopia. No patient developed recurrence of inflammation or increased muscle restriction.

Conclusions: Vertical rectus resection could be considered as an additional surgical strategy in the management of TED patients with vertical strabismus without adverse sequelae.
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http://dx.doi.org/10.1080/09273972.2018.1444067DOI Listing
June 2018

Inferior Oblique Botulinum Toxin Injection: A Postoperative Diplopia Test for Secondary Inferior Oblique Muscle Overaction.

J Pediatr Ophthalmol Strabismus 2016 Mar-Apr;53(2):80-4. Epub 2016 Feb 4.

Purpose: To evaluate the utility of botulinum toxin injection into the inferior oblique muscle for secondary inferior oblique muscle overaction.

Methods: A retrospective review of 18 patients and 23 injections performed over a 9-year period. Indications and deviations in primary position and contralateral gaze before and after injection were recorded. Functional outcomes and further management (conservative vs surgical) were observed.

Results: In 14 patients, chemodenervation resulted in a temporary improvement in symptoms. Eleven of these patients went on to have inferior oblique myectomy with resolution of their diplopia. Two patients preferred to receive regular injections of botulinum toxin as a treatment.

Conclusions: Botulinum toxin chemodenervation of the inferior oblique muscle in cases of secondary inferior oblique muscle overaction is useful where one needs to establish a risk of overcorrection following planned inferior oblique muscle weakening. This is particularly true in cases where the primary position deviation may be small but symptoms of diplopia exist on contralateral side gaze, giving rise to a narrowed field of binocular single vision.
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http://dx.doi.org/10.3928/01913913-20160122-06DOI Listing
December 2016

Unaugmented Muscle Union Surgery for Heavy Eye Syndrome Without Combined Medial Rectus Recession.

J Pediatr Ophthalmol Strabismus 2016 Jan-Feb;53(1):40-3

Purpose: Simple loop myopexy or retro-equitorial muscle union surgery has been shown to effectively treat the strabismus seen in heavy eye syndrome. In most cases, this has been described with combined recession of the medial rectus muscle, particularly where medial rectus contracture was demonstrated on forced duction testing intraoperatively. The authors report the outcomes of muscle union surgery alone without combined medial rectus recession in 29 eyes with heavy eye syndrome.

Methods: A retrospective review was conducted of 26 patients and 29 eyes with heavy eye syndrome treated with a simple loop myopexy procedure. The preoperative and postoperative deviations in primary position were measured along with restriction in ocular motility in abduction and elevation. Patients with residual esotropia and/or persistence of symptoms were offered a second-stage medial rectus recession procedure.

Results: In 21 patients, muscle union was sufficient in improving the diplopia or cosmetic appearance of the eyes. In these cases, the average preoperative deviation improved from 21.2 ± 16.3 to 5.5 ± 9.1 prism diopters (PD). Eight eyes went on to have a second-stage medial rectus recession with excellent outcomes.

Conclusions: The authors found that muscle union surgery alone is an effective and successful procedure in restoring the ocular motility disturbance and also in treating heavy eye syndrome. There was a much lower incidence (up to 70% lower) of medial rectus recession than other similar case series. There were no cases of overcorrection and no complications.
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http://dx.doi.org/10.3928/01913913-20160113-02DOI Listing
October 2016

Treatment of age-related distance esotropia with unilateral lateral rectus resection.

J AAPOS 2014 Oct 27;18(5):446-8. Epub 2014 Sep 27.

Royal Liverpool University Hospital, Liverpool, UK.

Purpose: To report the results of a series of patients who underwent lateral rectus resection of a single muscle using nonadjustable sutures to correct acquired concomitant esotropia (age-related distance esotropia).

Methods: The medical records of patients with symptomatic age-related distance esotropia who were treated by unilateral lateral rectus resection were retrospectively reviewed. Pre- and postoperative near and distance prism diopter measurements were compared.

Results: The average age of the patients was 79.8 years (range, 68-90 years). The mean lateral rectus resection was 4.9 ± 1.3 mm. All patients had complete resolution of diplopia after surgery. Median distance esotropia measurements in primary gaze were reduced from 16.0(Δ) preoperatively to 0(Δ) postoperatively (P < 0.005) at final follow-up. Any preoperative near esotropia was also completely resolved.

Conclusions: In this patient cohort, age-related distance esotropia was effectively managed solely with unilateral lateral rectus resection.
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http://dx.doi.org/10.1016/j.jaapos.2014.06.011DOI Listing
October 2014

Longitudinal study of winter mortality disease in Sydney rock oysters Saccostrea glomerata.

Dis Aquat Organ 2014 Jul;110(1-2):151-64

NSW Department of Primary Industries, Elizabeth Macarthur Agricultural Institute, Menangle, New South Wales 2568, Australia.

Winter mortality (WM) is a poorly studied disease affecting Sydney rock oysters Saccostrea glomerata in estuaries in New South Wales, Australia, where it can cause significant losses. WM is more severe in oysters cultured deeper in the water column and appears linked to higher salinities. Current dogma is that WM is caused by the microcell parasite Bonamia roughleyi, but evidence linking clinical signs and histopathology to molecular data identifying bonamiasis is lacking. We conducted a longitudinal study between February and November 2010 in 2 estuaries where WM has occurred (Georges and Shoalhaven Rivers). Results from molecular testing of experimental oysters for Bonamia spp. were compared to clinical disease signs and histopathology. Available environmental data from the study sites were also collated and compared. Oyster condition declined over the study period, coinciding with decreasing water temperatures, and was inversely correlated with the presence of histological lesions. While mortalities occurred in both estuaries, only oysters from the Georges River study site showed gross clinical signs and histological changes characteristic of WM (lesions were prevalent and intralesional microcell-like structures were sometimes noted). PCR testing for Bonamia spp. revealed the presence of an organism belonging to the B. exitiosa-B. roughleyi clade in some samples; however, the very low prevalence of this organism relative to histological changes and the lack of reactivity of affected oysters in subsequent in situ hybridisation experiments led us to conclude that this Bonamia sp. is not responsible for WM. Another aetiological agent and a confluence of environmental factors are a more likely explanation for the disease.
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http://dx.doi.org/10.3354/dao02629DOI Listing
July 2014

High-throughput direct fecal PCR assay for detection of Mycobacterium avium subsp. paratuberculosis in sheep and cattle.

J Clin Microbiol 2014 Mar 18;52(3):745-57. Epub 2013 Dec 18.

Faculty of Veterinary Science, University of Sydney, Camden, Australia.

Johne's disease (JD) is a chronic enteric disease caused by Mycobacterium avium subsp. paratuberculosis that affects ruminants. Transmission occurs by the fecal-oral route. A commonly used antemortem diagnostic test for the detection of M. avium subsp. paratuberculosis in feces is liquid culture; however, a major constraint is the 2- to 3-month incubation period needed for this method. Rapid methods for the detection of M. avium subsp. paratuberculosis based on PCR have been reported, but comprehensive validation data are lacking. We describe here a new test, the high-throughput-Johnes (HT-J), to detect M. avium subsp. paratuberculosis in feces. Its diagnostic accuracy was compared with that of liquid radiometric (Bactec) fecal culture using samples from cattle (1,330 samples from 23 herds) and sheep (596 samples from 16 flocks). The multistage protocol involves the recovery of M. avium subsp. paratuberculosis cells from a fecal suspension, cell rupture by bead beating, extraction of DNA using magnetic beads, and IS900 quantitative PCR. The limit of detection of the assay was 0.0005 pg, and the limit of quantification was 0.005 pg M. avium subsp. paratuberculosis genomic DNA. Only M. avium subsp. paratuberculosis was detected from a panel of 51 mycobacterial isolates, including 10 with IS900-like sequences. Of the 549 culture-negative fecal samples from unexposed herds and flocks, 99% were negative in the HT-J test, while 60% of the bovine- and 84% of the ovine-culture-positive samples were positive in the HT-J test. As similar total numbers of samples from M. avium subsp. paratuberculosis-exposed animals were positive in culture and HT-J tests in both species, and as the results of a McNemar's test were not significant, these methods probably have similar sensitivities, but the true diagnostic sensitivities of these tests are unknown. These validation data meet the consensus-based reporting standards for diagnostic test accuracy studies for paratuberculosis and the Minimum Information for Publication of Quantitative Real-Time PCR Experiments (MIQE) guidelines (S. A. Bustin et al., Clin. Chem. 55:611-622, 2009, doi:10.1373/clinchem.2008.112797). The HT-J assay has been approved for use in JD control programs in Australia and New Zealand.
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http://dx.doi.org/10.1128/JCM.03233-13DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3957769PMC
March 2014

Emergence of epizootic ulcerative syndrome in native fish of the Murray-Darling River System, Australia: hosts, distribution and possible vectors.

PLoS One 2012 25;7(4):e35568. Epub 2012 Apr 25.

New South Wales Department of Primary Industries, Port Stephens Fisheries Institute, Nelson Bay, New South Wales, Australia.

Epizootic ulcerative syndrome (EUS) is a fish disease of international significance and reportable to the Office International des Epizootics. In June 2010, bony herring Nematalosa erebi, golden perch Macquaria ambigua, Murray cod Maccullochella peelii and spangled perch Leiopotherapon unicolor with severe ulcers were sampled from the Murray-Darling River System (MDRS) between Bourke and Brewarrina, New South Wales Australia. Histopathology and polymerase chain reaction identified the fungus-like oomycete Aphanomyces invadans, the causative agent of EUS. Apart from one previous record in N. erebi, EUS has been recorded in the wild only from coastal drainages in Australia. This study is the first published account of A. invadans in the wild fish populations of the MDRS, and is the first confirmed record of EUS in M. ambigua, M. peelii and L. unicolor. Ulcerated carp Cyprinus carpio collected at the time of the same epizootic were not found to be infected by EUS, supporting previous accounts of resistance against the disease by this species. The lack of previous clinical evidence, the large number of new hosts (n = 3), the geographic extent (200 km) of this epizootic, the severity of ulceration and apparent high pathogenicity suggest a relatively recent invasion by A. invadans. The epizootic and associated environmental factors are documented and discussed within the context of possible vectors for its entry into the MDRS and recommendations regarding continued surveillance, research and biosecurity are made.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0035568PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3338419PMC
September 2012

The effect of scleral exoplant removal on strabismus following retinal detachment repair.

J AAPOS 2011 Aug;15(4):331-3

St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom.

Purpose: Scleral buckling for retinal detachment is a well-reported cause of secondary strabismus. We analyzed the effects on motility of removal of the exoplant alone to determine whether this is warranted as a separate step in the surgical management of these patients.

Methods: A retrospective case series of patients who underwent scleral exoplant removal due to symptomatic strabismus development following retinal detachment repair from 2007 to 2009 was conducted. Manifest horizontal and vertical deviations were treated as vectors of a single combined deviation (|dev|). Pre- and postoperative manifest |dev| in the primary position (|dev|(pp)) and in the gaze position of maximal deviation (|dev|(max)) were analyzed.

Results: Five patients were identified, all with symptomatic, binocular diplopia in the primary position prior to exoplant removal. Median |dev|(pp) prior to exoplant removal was 21(Δ) and following removal was 21(Δ) (P = 0.81). The median |dev|(max) prior to exoplant removal was 33(Δ) and following removal, 22(Δ) (P = 0.82). Median follow-up was 8 months. There were no cases of retinal redetachment following the exoplant removal. No patient reported any subjective improvement of their diplopia. All 5 patients went on to have strabismus surgery as a separate procedure.

Conclusions: Median primary position deviation was unchanged by scleral buckle removal, and Exoplant removal has minimal long-term benefit on the strabismus following scleral buckling procedures.
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http://dx.doi.org/10.1016/j.jaapos.2011.03.016DOI Listing
August 2011

Culture phenotypes of genomically and geographically diverse Mycobacterium avium subsp. paratuberculosis isolates from different hosts.

J Clin Microbiol 2011 May 23;49(5):1822-30. Epub 2011 Mar 23.

Faculty of Veterinary Science, The University of Sydney, Camden, NSW, Australia.

Mycobacterium avium subsp. paratuberculosis causes paratuberculosis (Johne's disease) in ruminants in most countries. Historical data suggest substantial differences in culturability of M. avium subsp. paratuberculosis isolates from small ruminants and cattle; however, a systematic comparison of culture media and isolates from different countries and hosts has not been undertaken. Here, 35 field isolates from the United States, Spain, Northern Ireland, and Australia were propagated in Bactec 12B medium and Middlebrook 7H10 agar, genomically characterized, and subcultured to Lowenstein-Jensen (LJ), Herrold's egg yolk (HEY), modified Middlebrook 7H10, Middlebrook 7H11, and Watson-Reid (WR) agars, all with and without mycobactin J and some with sodium pyruvate. Fourteen genotypes of M. avium subsp. paratuberculosis were represented as determined by BstEII IS900 and IS1311 restriction fragment length polymorphism analysis. There was no correlation between genotype and overall culturability, although most S strains tended to grow poorly on HEY agar. Pyruvate was inhibitory to some isolates. All strains grew on modified Middlebrook 7H10 agar but more slowly and less prolifically on LJ agar. Mycobactin J was required for growth on all media except 7H11 agar, but growth was improved by the addition of mycobactin J to 7H11 agar. WR agar supported the growth of few isolates. The differences in growth of M. avium subsp. paratuberculosis that have historically been reported in diverse settings have been strongly influenced by the type of culture medium used. When an optimal culture medium, such as modified Middlebrook 7H10 agar, is used, very little difference between the growth phenotypes of diverse strains of M. avium subsp. paratuberculosis was observed. This optimal medium is recommended to remove bias in the isolation and cultivation of M. avium subsp. paratuberculosis.
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http://dx.doi.org/10.1128/JCM.00210-11DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3122651PMC
May 2011

The psychosocial effects of strabismus: effect of patient demographics on the AS-20 score.

J AAPOS 2010 Dec;14(6):469-71

St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK.

Purpose: The introduction of the AS-20 strabismus-specific quality-of-life questionnaire allows clinicians to quantify the effects of strabismus on adults for the first time. We correlated strabismic patients' demographic and clinical findings to their AS-20 scores.

Methods: A consecutive cohort of patients from an ongoing prospective study of adults with manifest strabismus was recruited. The patients' age, sex, socioeconomic status (SES), magnitude, and direction of deviation were correlated to their AS-20 scores. Patients' zip codes were used to derive a score for their SES based on the English 2007 Index of Multiple Deprivation score (IMD2007).

Results: A total of 61 questionnaires with all demographic and clinical data were available. The median magnitude of deviation was 20.4(Δ) in this group. The mean AS-20 score was 49.5 (SD 21.6). Women had significantly lower AS-20 scores than men (p = 0.02). There was no difference in AS-20 scores between individuals with eso- and exodeviations (p = 0.7). Multiple linear regression analysis shows female sex and lower SES to be significantly associated with lower AS-20 scores (p = 0.03 and p = 0.006, respectively).

Conclusions: Strabismic patients who are female or live in a more deprived area have a significantly lower AS-20 score.
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http://dx.doi.org/10.1016/j.jaapos.2010.08.013DOI Listing
December 2010

The psychosocial effects of adult strabismus: a review.

Br J Ophthalmol 2011 Apr 18;95(4):450-3. Epub 2010 Sep 18.

Royal Liverpool University Hospital, Liverpool L7 8XP, UK.

Correction of adult strabismus is not a cosmetic procedure but one that restores normality to an individual's appearance that has been altered by a disease process. Two fundamental principles underpinning facial attractiveness are symmetry and averageness-manifest strabismus affects both of these giving an unconscious signal of poor genetic history. The presence of manifest strabismus adversely affects many aspects of patients' lives including finding a partner, job prospects and interaction with peers, and may manifest more seriously as psychiatric disorders. Surgical correction has been shown to be safe and effective for the functional problems of strabismus in adults but the hugely positive effects on the psychosocial aspects are only now becoming apparent. The advent of a new adult strabismus specific quality-of-life questionnaire and its subsequent validation will make this quantification of improvement easier. The wider medical community and the public at large should be made aware of the benefits of corrective strabismus surgery in adults.
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http://dx.doi.org/10.1136/bjo.2010.188425DOI Listing
April 2011

Perioperative management of anticoagulated patients having cataract surgery: National audit of current practice of members of the Royal College of Ophthalmologists.

J Cataract Refract Surg 2009 Oct;35(10):1815-20

Department of Ophthalmology, University Hospital Aintree, Liverpool, United Kingdom.

An 11-item questionnaire was mailed to 891 consultant members of the Royal College of Ophthalmologists (RCOphth) to audit compliance with RCOphth guidelines for perioperative management of anticoagulated patients having cataract surgery. Four hundred ninety-nine questionnaires were analyzed. The results showed that 29.5% of respondents adhered to all aspects of RCOphth guidelines; that is, they checked the international normalized ratio (INR) preoperatively, continued warfarin, operated within the desired therapeutic INR range for the condition that warfarin was being used to treat (as set by the treating physician), and considered sub-Tenon or topical anesthesia in anticoagulated patients.
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http://dx.doi.org/10.1016/j.jcrs.2009.05.042DOI Listing
October 2009

The role of botulinum toxin in decompensated strabismus.

Strabismus 2008 Jul-Sep;16(3):107-11

Department of Ophthalmology, St James' University Hospital, Leeds, United Kingdom.

Background: The surgical management of decompensated strabismus is well described. Conservative treatment may employ the use of lenses and prisms. However, the use of botulinum toxin in decompensated squint is poorly documented. In these patients, with the potential for fusion, botulinum toxin may serve to stabilize the ocular alignment by bringing the images within the fusion range.

Purpose: The aim of this study was to assess the role of botulinum toxin in the treatment of decompensated squints.

Methods: A retrospective case series involving 92 patients with decompensated squints between December 1990 and July 2005. Botulinum toxin was injected into the lateral rectus in 45 cases and into the medial rectus in 47. This was performed under local anesthesia in 74 cases, the remainder with ketamine anesthesia. Patients were assessed preoperatively at 2 weeks, 4 months, and a minimum of 12 months postoperatively. We defined successful treatment where the resultant stabilized deviation was less than or equal to 10 prism diopters with resolution of diplopia.

Results: In this study, 47 patients had a decompensated microesotropia and 45 had a decompensated exophoria. We found that 27 (29.3%) patients were asymptomatic following injection of botulinum toxin. Fourteen (15.2%) patients were better controlled and did not require further intervention. Subsequent surgery was performed in 45 patients (48.9%).

Conclusion: Our results suggest almost half of those patients requiring treatment for decompensated squint benefit from botulinum toxin, without requiring surgical intervention. This approach is less invasive and allows potential for recovery of binocular function.
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http://dx.doi.org/10.1080/09273970802292693DOI Listing
December 2008

Growth pattern and partial proteome of Mycobacterium avium subsp. paratuberculosis during the stress response to hypoxia and nutrient starvation.

Vet Microbiol 2009 Feb 5;133(4):344-57. Epub 2008 Aug 5.

The University of Sydney, Camden, NSW 2570, Australia.

Mycobacterium avium subsp. paratuberculosis is an important pathogen that causes Johne's disease in animals and has been implicated in Crohn's disease in man yet few data exist on its physiological adaptation in either the host or the environment. In this study, the proteomic responses of the two distinct strains of M. a. paratuberculosis, cattle (C) and sheep (S), to hypoxia and starvation were studied in vitro. Nutrient starvation inhibited growth of both strains and was lethal for S strain after 12 weeks. Hypoxia induced a state of very low metabolic activity but rapid resuscitation occurred upon restoration of an aerobic atmosphere, consistent with the dormancy response of other mycobacteria. A total of 55 protein spots differentially expressed in response to starvation and/or hypoxic stress in one or both strains were identified from 2D gels and classified based on biological function. Antioxidant enzymes, oxidoreducatse enzymes and proteins involved in amino acid metabolism, fatty acid metabolism, ATP and purine biosynthesis, proteolysis, cell wall synthesis, protein synthesis, signal recognition and hypothetical proteins with putative functions including dormancy response regulators and universal stress proteins were identified. These proteins are potential screening targets for future diagnosis, prevention and control of M. a. paratuberculosis infection and their identification will assist understanding the pathogenesis of diseases caused by this organism.
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http://dx.doi.org/10.1016/j.vetmic.2008.07.021DOI Listing
February 2009

Botulinum toxin injection for postoperative diplopia testing in adult strabismus.

J AAPOS 2008 Feb 25;12(1):46-8. Epub 2007 Oct 25.

Eye Department, Walton Hospital, Aintree University Hospital NHS Trust, Liverpool, United Kingdom.

Purpose: To investigate the use of botulinum toxin type A in identifying adult patients with constant strabismus who are at high risk of developing intractable diplopia after surgery.

Methods: A retrospective review of adult patients with constant horizontal strabismus who had botulinum toxin injection to evaluate their risk of postoperative diplopia. These patients reported diplopia when prisms were used to neutralize the deviation.

Results: One hundred ninety-five adults were studied; their mean age was 40.3 +/- 14 years (range, 16 to 73 years). One hundred thirty-three (68%) had botulinum toxin injected into a lateral rectus muscle; 62 (32%) had injections in a medial rectus muscle. Only 14 (7%) developed diplopia; 9 (4.6%) of these had troublesome diplopia but 5 (2.6%) could cope with the double vision and elected to have surgery. Surgical correction was recommended to the remaining 181 (93%) who did not experience diplopia. Complications of botulinum toxin injection were ptosis (10 patients, 5.1%) and superior oblique muscle weakness (3 patients, 1.5%). Twenty-six patients (13.3%) had a poor response to the first injection and required a second injection with a double dose. Surgery did not result in intractable diplopia after 6 weeks in any patient with a negative botulinum toxin diplopia test.

Conclusions: Botulinum toxin is a useful diagnostic tool for identifying patients with a low risk or no risk of postoperative diplopia despite a positive prism diplopia test.
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http://dx.doi.org/10.1016/j.jaapos.2007.07.006DOI Listing
February 2008

Evaluation of radiometric faecal culture and direct PCR on pooled faeces for detection of Mycobacterium avium subsp. paratuberculosis in cattle.

Vet Microbiol 2007 Nov 5;125(1-2):22-35. Epub 2007 May 5.

Elizabeth Macarthur Agricultural Institute, NSW Department of Primary Industries, Menangle, NSW, Australia.

Dilution rates for pooled faecal culture (PFC) and direct IS900 polymerase chain reaction (D-PCR) tests were evaluated on faecal samples from infected cows mixed with uninfected faeces in dilutions from 1 in 5 to 1 in 50. PFC was performed by radiometric culture, with confirmation by IS900 PCR and restriction endonuclease analysis (PCR/REA) on growth, and by mycobactin dependency testing on solid medium. Using 37 culture positive faecal samples from 12 subclinical cows, 83.8% and 94.6% of samples were confirmed positive in the PFC assay at dilutions of 1 in 50 and 1 in 30, respectively. Lower dilutions (1 in 5 to 1 in 20) provided only marginally better sensitivity, and confirmation of PFC growth by PCR/REA was significantly more sensitive than mycobactin dependency. D-PCR had significantly lower sensitivity than PFC confirmed by PCR/REA, with pools of 1 in 50, 30, 10 and 5 yielding positive results in 64.9%, 70.3%, 78.4% and 83.8% of samples, respectively. Cattle considered to be shedding 1.5 x 10(6) viable M. avium subsp. paratuberculosis (Map)/g faeces (on the basis of estimated losses in processing and growth rates in radiometric broth) were positive at dilutions up to 1 in 50 in the PFC and D-PCR. Those shedding 5 x 10(5) viable Map/g were positive in the PFC at dilutions up to 1 in 40, but required a 1 in 10 dilution or less for D-PCR. The results suggest that for cattle shedding relatively high concentrations of Map in faeces (>2 x 10(5) viable Map/g), maximal dilutions of 1 in 30 for PFC and 1 in 10 for D-PCR would be applicable.
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http://dx.doi.org/10.1016/j.vetmic.2007.04.043DOI Listing
November 2007

Adjustment of the surgical nomogram for surgery on slipped extraocular muscles.

J AAPOS 2006 Dec;10(6):573-6

Department of Ophthalmology, Walton Hospital, Rice Lane, Walton, Liverpool, United Kingdom.

Purpose: A slipped muscle is an underdiagnosed complication of strabismus surgery. Surgery necessitates intraoperative diagnosis, measurement, and resection of the empty sheath. We analyzed the results of empty sheath surgery for slipped medial and lateral rectus muscles in a large cohort of patients.

Methods: Eighty-five patients who underwent empty sheath surgery at a secondary referral center by a single strabismologist were included in the study. We retrospectively analyzed the preoperative and postoperative change in angle of deviation 6 weeks after surgery. All cases were reoperations in which an unexpected or unsatisfactory outcome followed primary surgery. Consecutive exotropias with slipped medial rectus muscles were noted in 68 patients. There were 17 esotropia cases with lateral rectus muscles slip, of which 2 were consecutive exotropias that became consecutive esotropias. Bilateral medial rectus muscle slips were found in 6 patients with consecutive exotropias. Adjustable suture surgery was performed in 27 patients.

Results: Resection of the empty sheath of the slipped medial or lateral rectus muscle with advancement to the original site of insertion was done in all cases; in addition, the antagonist muscle was recessed only if it was tight. The total muscle advancement was calculated in millimeters from the total amount of sheath resected, muscle advanced, and the antagonist recessed. The greater the preoperative deviation, the more surgical muscle advancement was required and the greater the change in postoperative angle of deviation. Mean change in angle of deviation was 3.13(delta) for each millimeter of muscle advancement (median = 3.00, SD = 1.72).

Conclusions: The diagnosis of slipped muscle should be confirmed during strabismus surgery. The empty sheath was measured, resected, and the muscle advanced to the original site of insertion. An approximate 3(delta) change in angle of deviation was observed for every millimeter of muscle of advancement. For very large and very small deviations, surgeons should modify this to an accustomed measurement dictated by their experience.
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http://dx.doi.org/10.1016/j.jaapos.2006.04.013DOI Listing
December 2006

Unaugmented vertical muscle transposition surgery for chronic sixth nerve paralysis.

Strabismus 2006 Dec;14(4):177-81

Department of Ophthalmology, Royal Liverpool University Hospital, Liverpool, UK.

Introduction: Chronic sixth nerve palsy can cause incapacitating diplopia requiring vertical muscle transposition surgery. Augmentation of surgery, with lateral fixation sutures, medial rectus recession or botulinum toxin injection, is associated with an increased risk of complications.

Purpose: Our aim was to evaluate the efficacy and safety of unaugmented full-tendon vertical rectus transposition in chronic sixth nerve paralysis.

Methods: Longitudinal study of 21 patients with chronic sixth nerve paralysis of longer than 6 months duration, who underwent superior and inferior recti transposition surgery without medial rectus recession or botulinum toxin injection. Details of surgery, preoperative and postoperative examinations including full orthoptic examination were obtained from an electronic database. Outcomes included the change in angle of deviation, the requirement for further surgery to the medial rectus and postoperative improvement in diplopia. SPSS software (Version 12.0.1, SPSS Inc. Chicago, IL) was used to summarize baseline characteristics and outcomes and to compare preoperative and postoperative deviation (paired t-test).

Results: Twenty-one patients (10 (47.6%) men and 11 (52.4%) women) with a mean age of 41 years (range 4 to 74 years) were operated in the period between April 1998 and November 2000. Eighteen patients had unilateral and three had bilateral acquired sixth nerve palsy. Nineteen patients required unilateral surgery and two had bilateral transposition procedures. In patients with unilateral sixth nerve palsy, mean esotropia in primary position before surgery was 46.7 prism-diopters (PD) (95% CI 35.9-57.4 PD) and improved to 14.6 PD after surgery (95% CI 6.4-22.7 PD). The angle of deviation was significantly reduced by an average of 32.1 PD (p < 0.001, paired t-test; 95% CI 22.6-41.6 PD). Over all, 10 patients (55.6%) had a well-controlled esophoria with a postoperative alignment of within 10 PD of orthophoria without diplopia in the primary position, for distance and near. A further six patients (28.6%) required additional medial rectus recessions to achieve success. The only complication observed was slippage of the inferior rectus in one patient (4.2%), who consequently required further surgery.

Conclusion: Botulinum toxin infiltration of the medial rectus in vertical rectus transposition surgery may be unnecessary, incurring cost, additional attendances and interventions for patients. Less than a third of all patients in our series required additional medial rectus recession later.
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http://dx.doi.org/10.1080/09273970601026201DOI Listing
December 2006

Corneal topographic features in a family with nanophthalmos.

Cornea 2006 Jul;25(6):750-6

Department of Ophthalmology, Aintree University Hospitals, Liverpool, United Kingdom.

Purpose: To characterize the corneal topographic features in a family with nanophthalmos.

Methods: Two observational case reports and a review of the literature. Corneal shape was analyzed using a topographic modeling system (TMS) and an Orbscan topographic system, with further analysis based on Fourier series and Zernicke polynomials. A control group was used for comparison.

Results: Two female family members with nanophthalmos belonging to the same generation showed significant irregular corneal astigmatism and corneal steepening.

Conclusion: Topographic corneal steepening and irregular astigmatism seems to be associated in 1 family with inherited nanophthalmos. Higher degrees of irregular astigmatism, which were not evident without a topographic analysis, may account, in part, for the unexplained visual reduction.
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http://dx.doi.org/10.1097/01.ico.0000220770.19402.50DOI Listing
July 2006

Genomic comparison of Mycobacterium avium subsp. paratuberculosis sheep and cattle strains by microarray hybridization.

J Bacteriol 2006 Mar;188(6):2290-3

Faculty of Veterinary Science, University of Sydney, Camden, NSW, Australia.

Microarray-based comparisons of three Mycobacterium avium subsp. paratuberculosis isolates, including one sheep strain and two cattle strains, identified three large genomic deletions in the sheep strain, totaling 29,208 bp and involving 24 open reading frames. These deletions may help explain some of the differences in pathogenicity and host specificity observed between the cattle and sheep strains of Mycobacterium avium subsp. paratuberculosis.
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http://dx.doi.org/10.1128/JB.188.6.2290-2293.2006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1428150PMC
March 2006

Survival of Mycobacterium avium subsp. paratuberculosis in dam water and sediment.

Appl Environ Microbiol 2005 Sep;71(9):5304-8

Faculty of Veterinary Science, The University of Sydney, Private Bag 3, Camden, NSW 2570, Australia.

In a previous longitudinal study, Mycobacterium avium subsp. paratuberculosis survived for 55 weeks in fecal material in the shade, but for much shorter periods in exposed locations. In this experiment, the survival of the organism was studied in 250 liters of dam water and sediment in large water troughs that were placed in either a semiexposed location or in a shaded location and compared to survival in fecal material and soil in the shaded location. Survival in water and/or sediment in the shade was for up to 48 weeks compared to 36 weeks in the semiexposed location. Survival in sediment was 12 to 26 weeks longer than survival in the water column. Survival in soil and fecal material in the terrestrial environment in the shaded location was only 12 weeks. Although disturbance to sediment could not be ruled out as a factor, there was evidence of dormancy in both the water column and the sediment, since the organism could not be recovered for several months before again becoming detectable. The results suggest that water may be a significant reservoir of M. avium subsp. paratuberculosis infection. Further research on the biology of the organism in aquatic environments is warranted. Animal health authorities will need to provide appropriate advice to farmers to minimize exposure of livestock to potentially infected water sources. Survival of the organism in water destined for human consumption will need to be addressed if the organism is found to be involved in the etiology of Crohn's disease.
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http://dx.doi.org/10.1128/AEM.71.9.5304-5308.2005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1214599PMC
September 2005

Detection of the slipped extraocular muscle after strabismus surgery.

Ophthalmology 2005 Apr;112(4):686-93

Vision Assessment Unit, Department of Ophthalmology, Royal Liverpool Children's Hospital, Liverpool, United Kingdom.

Purpose: To estimate the frequency of slipped extraocular muscle (SM) in cases of repeat strabismus surgery and to compare the results of a number of putative preoperative tests for the detection of SM, with direct intraoperative inspection and histologic confirmation.

Design: Retrospective analysis of audit records followed by prospective interventional case series.

Participants: Case records of 715 adults presenting for repeat surgical correction of horizontal strabismus. Five patients suspected of having horizontal SM were consecutively recruited for the prospective case series.

Methods: Slipped extraocular muscle frequency was determined retrospectively from surgical outcome data in 715 adult horizontal strabismus surgeries in 1 center. A separate prospective study examined 5 participants with putative SM in detail. Gaze-dependent clinical tests (squint magnitude, eye movement range, palpebral fissure widening, naked-eye saccadic velocity estimation, intraocular pressure change) and saccade main sequence parameters (infrared eye-tracking) were recorded before and 2 weeks after corrective surgery. Intraoperative diagnosis was made by direct muscle examination and confirmed by histologic examination. Length of slippage and forced duction tests were intraoperative outcome measures.

Results: Slipped extraocular muscle frequency was 10.6%. The muscles of 3 participants in the prospective series were slipped. Direct intraoperative inspection accurately identified all SM cases. All other clinical tests produced false-positive and false-negative results, although SM was suggested preoperatively by limited eye movement range. Distorted saccadic velocity profiles were significantly (P<0.0001) associated with prior strabismus surgery. Saccade main sequence parameters were not diagnostic for SM.

Conclusions: Direct intraoperative inspection can accurately diagnose SM. Preoperative diagnosis of long-standing SM was not possible. In contradiction to a previous report, SM was not reliably associated with reduced peak saccadic velocity. The association between distorted saccadic velocity profiles and previous strabismus surgery is, to our knowledge, reported here for the first time.
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http://dx.doi.org/10.1016/j.ophtha.2004.11.048DOI Listing
April 2005

Survival and dormancy of Mycobacterium avium subsp. paratuberculosis in the environment.

Appl Environ Microbiol 2004 May;70(5):2989-3004

Faculty of Veterinary Science, The University of Sydney, Sydney, Australia.

The survival of Mycobacterium avium subsp. paratuberculosis was studied by culture of fecal material sampled at intervals for up to 117 weeks from soil and grass in pasture plots and boxes. Survival for up to 55 weeks was observed in a dry fully shaded environment, with much shorter survival times in unshaded locations. Moisture and application of lime to soil did not affect survival. UV radiation was an unlikely factor, but infrared wavelengths leading to diurnal temperature flux may be the significant detrimental component that is correlated with lack of shade. The organism survived for up to 24 weeks on grass that germinated through infected fecal material applied to the soil surface in completely shaded boxes and for up to 9 weeks on grass in 70% shade. The observed patterns of recovery in three of four experiments and changes in viable counts were indicative of dormancy, a hitherto unreported property of this taxon. A dps-like genetic element and relA, which are involved in dormancy responses in other mycobacteria, are present in the M. avium subsp. paratuberculosis genome sequence, providing indirect evidence for the existence of physiological mechanisms enabling dormancy. However, survival of M. avium subsp. paratuberculosis in the environment is finite, consistent with its taxonomic description as an obligate parasite of animals.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC404446PMC
http://dx.doi.org/10.1128/aem.70.5.2989-3004.2004DOI Listing
May 2004

Botulinum toxin and the eye.

Authors:
Ian B Marsh

Hosp Med 2003 Aug;64(8):464-7

University Hospital Aintree, Walton Hospital, Liverpool L9 1AE.

Botulinum toxin in ophthalmology is used to reduce the function of the eyelid muscles in spasms or therapeutically. Therapeutic and diagnostic use in strabismus is also discussed, along with the controversial treatment of nystagmus.
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http://dx.doi.org/10.12968/hosp.2003.64.8.2260DOI Listing
August 2003