Interventions for late trabeculectomy bleb leak

BACKGROUND: Late trabeculectomy bleb leaks are a common complication after filtering glaucoma surgery. Although asymptomatic, late bleb leaks may lead to hypotony and are associated with bleb related infections.

OBJECTIVES: To assess the effects of interventions for late trabeculectomy bleb leak.

SEARCH METHODS: We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2012, Issue 7), MEDLINE (January 1946 to July 2012), EMBASE (January 1980 to July 2012), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 18 July 2012.

SELECTION CRITERIA: We included randomised and quasi-randomised trials in which any treatments for eyes with late bleb leak (interventional and non-interventional) were compared with each other.

DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial quality and extracted data. We contacted study authors when additional information was needed.

MAIN RESULTS: The review included one multicentre trial based in the USA with 30 eyes of 30 participants. The trial compared two surgical procedures (conjunctival advancement and amniotic membrane transplant) to cover a filtering bleb leak. Conjunctival advancement has been shown to be more effective in sealing filtering bleb leaks.

AUTHORS' CONCLUSIONS: Although a variety of treatments have been proposed for bleb leaks, there is no evidence of their comparative effectiveness.The evidence in this review was provided by a single trial that compared two surgical procedures (conjunctival advancement and amniotic membrane transplant). The trial did show a superiority of conjunctival advancement, which was regarded as standard treatment, to amniotic membrane transplantation. There is a need for more randomised trials to validate the findings of this single trial and provide more information on the different types of interventions, especially non-surgical treatments compared to surgical procedures. We recommend that any intervention should be compared to a standard procedure, which is to date conjunctival advancement.

Late-stage, primary open-angle glaucoma in Europe:Social and health care maintenance costs and quality of life of patients from 4 countries

Objective: The purpose of this study was to estimate costs and quality of life (QoL) of late-stage glaucoma patients in 4 European countries. Methods: Retrospective review of medical charts of patients with POAG who were followed in a low-vision or vision rehabilitation center in one of 4 countries for at least 1 year was used to determine patient characteristics, health status, and health care resource use. Visual impairment was measured by best-corrected visual acuity (Snellen score). Patients were also interviewed over the telephone in order to assess their health-related QoL (using EuroQol EQ-5D) and use of resources including: the number of visits to rehabilitation centers, visits to hospital and non-hospital specialists, the use of low-vision devices, medication, tests, and the use of hired home help. The costs associated with resource use were calculated from the perspective of a third-party payer of health and social care based on resource usage and unit costs in each country. Results: Patients undergoing visual rehabilitation in France (n=21), Denmark (n=59), Germany (n=60), and the United Kingdom (n=22) were identified, interviewed and had their medical charts reviewed. Annual maintenance costs of late-stage glaucoma amounted to €830 (±445) on average. Average home help costs were more than 3 times higher. QoL, on average, was 0.65 (±0.28). QoL was positively correlated with the level of visual acuity in the patients' best eye. On the other hand, visual acuity was also positively correlated to health care costs, but negatively correlated to costs of home help. Conclusions: The study was limited by its observational, uncontrolled design. The finding that late-stage glaucoma is associated with higher home help costs than health care maintenance costs suggests that potential savings from a better preventive treatment are to be found for social care payers rather than health care payers. © 2008 Informa UK Ltd All rights reserved.

“La littérature est la seule patrie”: Nabile Farès and the Poetry of Postcolonial Displacment

Nabile Farès is a key author within postcolonial studies, due in particular to his uniquely expressive writing style. This article discusses writing style in his 1982 text, L’état perdu: précédé du discours pratique de l’immigré. Throughout the mainly French text, different alphabets are woven, alluding to the complexity of Algerian linguistic history and the importance of language in the construction and expression of identity. Meanwhile, the grammar and structure of the French language seems confused and at times illogical, raising further questions about use of a colonial language in a postcolonial context. Farès’s writing style is avant-garde in nature, and deliberate intertextuality with the Surrealists situates the text within an avant-garde tradition in the French language, developing new ideas surrounding the effect of this written genre in the aftermath of colonialism.

Late Pleistocene climate change and landscape dynamics in the Eastern Alps: the inner-alpine Unterangerberg record (Austria)

Drill cores from the inner-alpine valley terrace of Unterangerberg, located in the Eastern Alps of Austria, offer first insights into a Pleistocene sedimentary record that was not accessible so far. The succession comprises diamict, gravel, sand, lignite and thick, fine grained sediments. Additionally, cataclastic deposits originating from two paleo-landslide events are present. Multi-proxy analyses including sedimentological and palynological investigations as well as radiocarbon and luminescence data record the onset of the last glacial period (Wurmian) at Unterangerberg at similar to 120-110 ka. This first time period, correlated to the MIS 5d, was characterised by strong fluvial aggradation under cold climatic conditions, with only sparse vegetation cover. Furthermore, two large and quasi-synchronous landslide events occurred during this time interval. No record of the first Early Wiirmian interstadial (MIS 5c) is preserved. During the second Early Wiirmian interstadial (MIS 5a), the local vegetation was characterised by a boreal forest dominated by Picea, with few thermophilous elements. The subsequent collapse of the vegetation is recorded by sediments dated to similar to 70-60 ka (i.e. MIS 4), with very low pollen concentrations and the potential presence of permafrost. Climatic conditions improved again between similar to 55 and 45 ka (MIS 3) and cold-adapted trees re-appeared during interstadials, forming an open forest vegetation. MIS 3 stadials were shorter and less severe than the MIS 4 at Unterangerberg, and vegetation during these cold phases was mainly composed of shrubs, herbs and grasses, similar to what is known from today's alpine timberline. The Unterangerberg record ended at similar to 45 ka and/or was truncated by ice during the Last Glacial Maximum. (C) 2013 Elsevier Ltd. All rights reserved.

"From Indomania to Indophobia":Thomas De Quincey's Providential Orientalism

Thomas De Quincey’s terrifying oriental nightmares, reported to sensational acclaim in his Confessions of an English Opium-Eater (1821), have become a touchstone of romantic imperialism in recent studies of the literature of the period (Leask 1991; Barrell 1992 et al). De Quincey’s collocation of “all creatures, birds, beasts, reptiles, all trees and plants, usages and appearances, that are found in all tropical regions” in the hypnagogic hallucinations that characterized what he called “the pains of opium” seems to anticipate neatly Said’s theory of orientalism, whereby the orient was supplied by the west with “a mentality, a genealogy, an atmosphere,” the attitudinal basis as he argues for the continuing march of imperialism from the late eighteenth century. Yet, as Thomas Trautmann (1997) has pointed out, orientalist scholarship based in India and led by the influential Asiatic Society of Bengal in the late eighteenth century was extremely enthusiastic about Indian classical antiquity. The early orientalist scholarship posited ethnic, linguistic, cultural and religious links between Europe and India, while recognizing the greater antiquity of Indian civilization. This favourable attitude (which Trautmann calls “Indomania”) was overtaken in the nineteenth century by disavowal of that scholarship and repugnance (which he calls “Indophobia”), influenced by utilitarian and evangelical attitudes to colonialism. De Quincey’s lifespan covers this crucial period of change. My paper examines his evangelical upbringing and interest in biblical and orientalist scholarship to suggest his anxious investment in these modes of thinking. I will suggest that the bizarre orientalist fusions of his dreams can be better understood in the context of changing attitudes to the imperialism during the period. An examination of his work provides a far more dynamic understanding of the processes of orientalism than the binary model suggested by Said. The transformation implied from imperial scholarship to governance, I will suggest, is not irrelevant to a world which continues to pull apart on various grounds of race and ethnicity, and reflects on our own role in the academy today.

'Translated Verse': Milton's Latin Poetry in the Long Eighteenth Century

This chapter assesses ways in which the emergence in the long eighteenth century of a cluster of verse translations of Milton’s Poemata engendered an intellectual discourse and debate on translation itself, not dissimilar to the magazine warfare of the day. It argues that poetical renderings of Milton’s Latin verse, and the biographical and literary contexts in which they appeared, facilitated the interrogation of key issues that are still being debated by modern translation theorists: the nature and function of translation; the viability of rendering a source text in a target language that is also in this instance a poetic language; the potential ‘fetters’ which, in Drydenesque terms, might constrain ‘the verbal copier’; or by contrast the quasi-liberating fluency, the ‘fluent strategy’, attendant upon recourse to verse as translational medium; canonicity, amplification and omission; the much-debated issue of authorial equivalence, evinced here, it is suggested, by the editorial showcasing of the translator; and not least, the perennial question of translation as reading and critical interpretation. In short, verse renderings of Milton’s Latin poetry and the debates that they engendered assume a not inconsequential place in the history of translation theory, which, as Venuti notes, is forever concerned with ‘the changing relationships between the relative autonomy of the translated text and two other categories: equivalence and function.’

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Marvell's Latin Poetry and the Art of Punning

This chapter analyses Marvell’s linguistic ingenuity as exemplified by his Latin poetic corpus. Here, it is argued, a pseudo Lucretian sensitivity to the parallelism between the structure of Latin words and the structure of the world co-exists with a linguistic methodology that is essentially Marinesque. Close examination of the Latin poems as a whole assesses the nature and significance of etymological play, paronomasia, puns on juxtaposed Latin words, on place names, and on personal names. It is suggested that such devices demonstrate ways in which the neo-Latin poetic text can serve both as a linguistic microcosm of the literary contexts in which they are employed, and as a re-invention of the artifice, extravagant conceits, and baroque wit of Marinism. The result is a neo-Latin ‘echoing song’ that is both intra- and intertextual. Through bilingual punning and phonological wit Marvell plays with a classical language only to demonstrate its transformative potential. The chapter concludes by offering a new reading of Hortus in relation to the garden sections of Marino’s L’Adone, in which an extravagantly luscious setting confounds the senses and is mirrored linguistically by word-clusters and labyrinthine punning.