Changes in Corneal Sensation, Tear Film Stability and Ocular Surface after Advanced Surface Ablation

PURPOSE: To evaluate the changes in tearfilm, corneal sensation and ocular surface after advanced surface ablation. METHODS: Tearfilm break-up time (BUT), Schirmer test without local anesthesia, fluorescein staining, corneal sensitivity test, ocular surface disease index (OSDI), and conjunctival impression cytology were evaluated in 50 eyes of 25 patients who underwent advanced surface ablation preoperatively and postoperatively at 2 weeks and at 1, 2, 3, and 6 months. Each value was compared to the preoperative value. RESULTS: OSDI diminished by 2 weeks postoperatively, and corneal sensation diminished by 1 month postoperatively (p < 0.05). There were significant decreases in BUT by 2 weeks to 1 month postoperatively as well as decreases in the Schirmer test by 2 to 3 months postoperatively (p < 0.05). Fluorescein staining increased at 2 weeks postoperatively (p < 0.05). Goblet cells decreased substantially by 1 month postoperatively and conjunctival squamous metaplasia increased significantly by 2 months postoperatively (p < 0.05). CONCLUSIONS: Advanced surface ablation may affect tearfilm, corneal sensation and ocular surface up to 3 months postoperatively. Early treatment of dry eye syndrome following advanced surface ablation should strongly be considered.

Changes in Tear Film, Cornea and Ocular Surface According to the Duration of Soft Contact Lens Wear

PURPOSE: The present study evaluated the changes in tear film, cornea and ocular surface according to the duration of soft contact lens wear. METHODS: A total 65 patients with 130 eyes were enrolled the present study, and were divided into 4 grous. The control group (group A) was composed of 32 eyes of 16 patients who had not worn soft contact lenses, group B, (34 eyes of 17 patients), had worn soft contact lenses less than 5 years, group C, (32 eyes of 16 patients), had worn soft contact lenses for 5 to 10 years and group D, (32 eyes of 16 patients), had worn soft contact lenses for more than 10 years. The tear break-up time (BUT), Schirmer's test, corneal sensitivity test, central corneal thickness, ocular surface disease index (OSDI), corneal fluorescein staining score, specular microscopy and conjunctival impression cytology were analyzed. The results were compared between the control group and the soft contact lens groups. RESULTS: In group B, BUT significantly decreased, but corneal fluorescein staining score and squamous metaplasia significantly increased (p < 0.05). In group C, OSDI and snake-like chromatin pattern significantly increased, but corneal thickness and goblet cell density significantly decreased (p < 0.05). In group D, the coefficient of variation for endothelium significantly increased, but corneal sensitivity and hexagonality significantly decreased (p < 0.05). CONCLUSIONS: Duration of soft contact lens wear influences changes in tear film, cornea and ocular surface.

Bleb Morphology of Fornix-Based Versus Limbus-Based Conjunctival Flaps in Trabeculectomy with Mitomycin C

PURPOSE: To compare the bleb morphology and surgical outcomes of a limbus-based group with those of a fornix-based group who underwent trabeculectomy with mitomycin C (MMC). METHODS: Sixty-five eyes of 59 patients who had undergone trabeculectomy with MMC and who were observed for one year or more were included in the present study. A limbus-based conjunctival flap was used for 34 eyes of 31 patients and a fornix-based conjunctival flap for the other 31 eyes of 28 patients. The bleb morphologies were classified and compared after one year or more postoperatively according to the Moorfield Bleb Grading System, and intraocular pressure and success rates were evaluated. RESULTS: The central bleb vascularity of the limbus-based group was statistically significantly lower than that of the fornix- based group (1.79 +/- 0.64; 2.16 +/- 0.73, p = 0.042). The risk of cystic bleb formation was higher in the limbus-based group (38.2%; 16.5%, p = 0.047). There were no differences in the IOP or success rate between the two groups. CONCLUSIONS: There were no differences between the two groups with regard to the IOP or cumulative success rate. However, in the fornix-based group, the central bleb vascularity was lower and the risk of avascular cystic bleb formation was higher than those in the limbus-based group.

The Accuracy of Estimating Postoperative Deviation in Exotropia With over 40 Prism Diopters

PURPOSE: To assess the accuracy of estimating postoperative deviation in large-angle exotropia over 40 prism diopters (PD). METHODS: A retrospective analysis was performed on 61 exotropia patients with over 40 PD exotropia who had undergone 2-muscle surgery by two surgeons and with at least 6 months follow-up. The accuracy was assessed by analyzing the discrepancy between preoperatively predicted residual deviation and deviation at postoperative 6weeks. Successful surgery was defined as deviation within +/- 10 PD at the last postoperative visit. RESULTS: More accurate residual deviation was predicted in exotropia with prism diopters between 40 and 59 (97.8%) than in exotropia with 60 PD or more (62.5%). And there was no significant difference between two surgeons. Surgical success rates at six months and one year after surgery were 96.8%, 94.7% in exotropia with 40 to 49 PD, 71.4%, 60.0%, 50 to 59 PD, 50.0%, 45.5%, 60 PD or more, respectively. There were four patients of whom the postoperative deviation angle exceeded more than 10 PD of the estimated deviation. CONCLUSIONS: The accuracy of estimating residual deviation prior to surgery was higher and more successful surgery was achieved in exotropia ranging in 40 to 59 PD than in exotropia with 60 PD or more. Therefore, 2- muscle surgery will be suitable for large-angle exotropia with less than 60 PD.

Clinical Research on Surgical Treatment for Double-Head Pterygium

PURPOSE: To evaluate two surgical methods-amniotic membrane transplantation (AMT) and split-conjunctival grafts (SCG)-for double-head pterygium, with regard to the postoperative outcome and recurrence rate. METHODS: In a total of 16 eyes (14 patients), 7 eyes (6 patients) receiving amniotic membrane transplantation and 9 eyes (8 patients) receiving split-conjunctival grafts were compared to evaluate recurrence and complications. RESULTS: Within the amniotic membrane transplantation group, two eyes (29%) had corneal recurrence, and 3 eyes (43%) had conjunctival recurrence. The mean follow-up period was 21.9+/-3.5 months, and all recurrences were on the nasal side. The average period preceding the corneal recurrences was 7.2+/-1.8 months. Within the split-conjunctival grafts group, the mean follow-up was 13.6+/-2.1 months, and neither the corneal nor conjunctival recurrences were observed. In addition, the eyes of this group were more aesthetically stable, with only one eye exhibiting pseudo-pterygium at the donor site. CONCLUSIONS: In cases of double-head pterygium without contraindication of conjunctival autograft, the split-conjunctival grafts produced fewer recurrences and showed enhanced cosmetic results, as compared to the amniotic membrane transplantation, indicating that the split-conjunctival grafts is the superior choice over amniotic membrane transplantation.

Scleral Allografting and Amniotic Membrane Transplantation With Fibrin Glue in the Management of Scleromalacia

PURPOSE: To examine the effects, complications, and safeties of sclera allograft and amniotic membrane transplantation with fibrin glue as surgical treatment methods for scleromalacia. METHODS: The study included 14 eyes of 14 scleromalacia patients who needed surgical treatment. Among them, seven eyes of seven patients whose scleral defect was small (6 mm) were operated on using fibrin glue and minimum suturing. Amniotic membrane transplantation was performed at the site of the conjunctival defect. RESULTS: In all of the cases, the results of grafting were successful throughout the follow-up period, which was 14.6+/-4.4 months, on average (ranging from 12 to 27 months). No particular complication was observed during the follow-up period after using fibrin glue. CONCLUSIONS: For scleromalacia patients, sclera allograft and amniotic membrane transplantation were performed using fibrin glue. The grafted sclera survived successfully, allowing this treatment modality to be considered an effective and safe option without complications.

Clinical Research on Effectiveness of Mitomycin C on Primary Pterygium With Limbal-Conjunctival Autograft

PURPOSE: To evaluate the effectiveness of Mitomycin C used as a combined therapy along with limbal-conjunctival autograft for primary pterygium. METHODS: Thirty eyes of 29 patients received Mitomycin C (0.02% MMC 3 minutes) with limbal-conjunctival autograft, and 30 eyes of 28 patients received limbal-conjunctival autograft alone. Recurrence and complications were evaluated in the patients at 2 weeks, 1, 3, 6 and 12 months postoperatively. RESULTS: Mean follow-up periods were 13.4+/-2.1 and 13.9+/-2.9 months, respectively. Between the two groups, recurrence in the conjunctiva or the cornea was not observed during the follow-up period. In the Mitomycin C use group, complications included a granuloma at the donor site (1 eye, 3.3%), wound dehiscence (2 eyes, 6.7%), and subgraft hemorrhage (2 eyes, 6.7%). In comparison, in the group treated with limbal-conjunctival autograft alone, complications included granuloma at the donor site (1 eye, 3.3%), pseudopterygium at the donor site (1 eye, 3.3%), wound dehiscence (3 eyes, 10%), and subgraft hemorrhage (2 eyes, 6.7%). CONCLUSIONS: The use of Mitomycin C as an adjuvant therapy has no significant effect on the recurrence rate in primary pterygium with limbal-conjunctival autograft.

Intravitreal Triamcinolone Versus Bevacizumab for Treatment of Diabetic Macular Edema

PURPOSE: To compare central macular thickness (CMT) and visual acuity outcomes after intravitreal injection of triamcinolone acetonide or bevacizumab for the treatment of diabetic macular edema (DME). METHODS: Fifty-one patients were randomly choosen to receive an intravitreal injection of either triamcinolone acetonide or bevacizumab. Patients were retrospectively reviewed, and 28 of 51 received an intravitreal injection of triamcinolone acetonide while the remaining 23 received bevacizumab injection. All patients underwent Snellen visual acuity testing, optical coherence tomography imaging and ophthalmoscopic examination at baseline and at four weeks following the injection. RESULTS: In the triamcinolone group, CMT decreased from 656.71+/-194.37 micrometer at baseline to 312.46+/-102.14 micrometer at the four-week follow-up visit, while in the bevacizumab group, CMT decreased from 582.17+/-151.02 micrometer at baseline to 453.09+/-172.39 micrometer at the follow-up (p<0.05). The LogMAR best-corrected visual acuity converted from the Snellen visual acuity significantly improved in the triamcinolone group (from 0.89+/-0.38 to 0.67+/-0.33) compared to the bevacizumab group (from 0.79+/-0.31 to 0.70+/-0.34) [p<0.05]. CONCLUSIONS: Intravitreal injection of triamcinolone may offer advantages over bevacizumab in the short-term management of DME, specifically with respect to improvement in CMT and visual acuity.

Intravitreal Triamcinolone Versus Bevacizumab for Treatment of Diabetic Macular Edema

PURPOSE: To compare central macular thickness (CMT) and visual acuity outcomes after intravitreal injection of triamcinolone acetonide or bevacizumab for the treatment of diabetic macular edema (DME). METHODS: Fifty-one patients were randomly choosen to receive an intravitreal injection of either triamcinolone acetonide or bevacizumab. Patients were retrospectively reviewed, and 28 of 51 received an intravitreal injection of triamcinolone acetonide while the remaining 23 received bevacizumab injection. All patients underwent Snellen visual acuity testing, optical coherence tomography imaging and ophthalmoscopic examination at baseline and at four weeks following the injection. RESULTS: In the triamcinolone group, CMT decreased from 656.71+/-194.37 micrometer at baseline to 312.46+/-102.14 micrometer at the four-week follow-up visit, while in the bevacizumab group, CMT decreased from 582.17+/-151.02 micrometer at baseline to 453.09+/-172.39 micrometer at the follow-up (p<0.05). The LogMAR best-corrected visual acuity converted from the Snellen visual acuity significantly improved in the triamcinolone group (from 0.89+/-0.38 to 0.67+/-0.33) compared to the bevacizumab group (from 0.79+/-0.31 to 0.70+/-0.34) [p<0.05]. CONCLUSIONS: Intravitreal injection of triamcinolone may offer advantages over bevacizumab in the short-term management of DME, specifically with respect to improvement in CMT and visual acuity.

MR Findings of Central Nervous System Involvement in Acquired Immunodeficiency Syndrome Patient: A Report of Two Cases

Central nervous system (CNS) manifestations in acquired immunodeficiency syndrome (AIDS) patients are an earlyand common feature. The spectrum of AIDS-related CNS diseases are encephalitis caused by the human immunodeficiency virus(HIV) itself, opportunistic infection, infarct and malignancy. We experienced two cases of CNS involvement in AIDS and they were serologically diagnosed as HIV encephalitis and CNS toxoplasmosis, respectively. In the case of the HIV encephalitis patient, brain MRI showed a non-enhancing lesion with high signal intensity on T2WI and low signal on T1WI and there was no mass effect on the right frontal lobe,periventricular white matter, splenium of the corpus callosum or bilateral basal ganglia. In the other case of CNS toxoplasmosis, MR showed multiple nodular and rim enhanced mass lesions in the right basal ganglia, thalamus and periventricular white matter, which were of low signal intensity on T1WI and of high intensity on T2WI. We thus report the related MRI findings.