Expression of growth factor, extracellular matrix and antioxidant (N-acetylcysteine) effect in TGF beta1 treated rat lens system

PURPOSE: The objective of this study was to characterize transdifferentiated lens epithelial cells analyzed by reverse transcription-polymerase chain reaction (RT-PCR) for the expression of mRNAs encoding growth factors, growth factor receptors and pathologic extracellular matrix proteins and by Western blot analysis for the proteins encoded by these mRNAs. Moreover, after antioxidants treatment, such as Nacetyl cysteine (NAC), we observed the effect on changes in the expression of growth factors, growth factor receptors and extracellular matrix proteins. METHODS: TGF-beta treated rat lens cultured with medium 199 (Sigma Co. St. Louis, MO) was subject to RT-PCR and Western blot analysis to assess expression of mRNAs and proteins encoded by these mRNAs. RESULTS: The expression of mRNAs for TGF-beta 1, TGF-beta 2, TGF-beta 3, TGF-beta receptor, epidermal growth factor (EGF), epidermal growth factor receptor, fibroblast growth factor (FGF), fibroblast growth factor receptor and connective tissue growth factor (CTGF) were increased. The levels of type I collagen, fibronectin, and alpha-smooth muscle actin (SMA) mRNAs were also increased. However, the expression of growth factors, receptors, extracellular matrix were decreased by antioxidant, such as NAC. CONCLUSIONS: The enhanced expression of growth factors, growth factor receptors and extracellular matrix in present the molecular mechanism underlying pathogenesis of cataracts. And the suppression of growth factors and growth factor receptors with treatment of antioxidants, such as NAC, suggests the possibility of using drugs in the prevention or treatment of cataracts.

Immunohistochemical Distribution of Heme Oxygenase Isoenzymes in Developing Rat Retina

PURPOSE: To analyze and compare the immunohistochemical distributions of HO-1 and HO-2 with the developmental process of retina, focusing on the time of birth and opening eyes because it is the time of the exposure to hyperoxia and light exposure. METHODS: The retina of 16-day-old embryo, 18-day-old embryo, 20-day-old embryo and postnatal rats at 0 day, 5 days, 10 days, 15 days, 20 days, 1 month, 2 months, 3 months were examined by hematoxylineeosin staining and immunohistochemistry of HO-1 and HO-2. RESULTS: Similar distribution of HO-1 and HO-2 from embryo to mature retina were observed. It was observed that HO-1 and HO-2 was contained in ganglion cell layer, inner plexiform layer, inner nuclear layer, outer plexiform layer and pigment layer of the mature retina. In the developmental process, reactivity was observed in the cell body of ganglion cells after 0 day of its birth. The reactivity was increased after 5 days of its birth, staining was observed in nerve cell and nerve fiber of ganglion cell layer, inner plexiform layer, inner segment of neuroblastic layer, pigment layer at this time. Reactivity of ganglion cell layer and pigment layer was increased intensively after 15 days of its birth and weak reactivity in some of horizontal cells and amacrine cells in inner plexiform layer was observed. The same distribution as that of mature retina was observed after 20 days of its birth. CONCLUSIONS: HO-1 and HO-2 expression was temporally and spatially correlated with the normal development of retina in rats. HO was concerned with the structure and function of retinal development by the activation of its products and with anti-oxidant mechanism on the time of birth and opening eyes.

A Case of Optic Nerve Infiltration of Acute Lymphocytic Leukemia

Leukemia is a common malignancy in childhood and has various associated ocular manifestations. Clinically, retina is the most commonly involved site and papilledema may be observed due to either direct infiltration or CNS involvement of leukemia. We have experienced a case of mass-like leukemic infiltration in retina and optic nerve in a 16-year-old ALL patient who presented with sudden reduction of visual acuity. With systemic chemotherapy, intrathecal methotrexate and radiotherapy, visual acuity and fundus findings improved. We report this unusual condition with a review of previous report.

Immunohistochemical Study for EGFR and PCNA with Electron Micrographic Study of Corneal Epithelium in Growing Rats

We have investigated where the stem cells located in the corneal epithelium by using immunohistochemistry for EGFR and PCNA and electron microscopic study. EGFR and PCNA immunoreactivities were observed in the basal epithelial layer in the entire cornea from postnatal day 10, when increased stratification of epithelium was also observed. But in adult, immunoreactive cells were found only in the limbal basal cells. And the basal cells in limbal epithelium maintained their ovoid or round shape even in adult. The basal cells of the limbus had euchromatic nuclei and rich cytoplasmic organelles, compatible with stem cells. Wide intercellular space and polarity of basal cells at postnatal 10 days seems to be associated with cellular migration for increased stratification of epithelium. These results suggest that stem cells are located in the basal layer of the entire corneal epithelium during development. But it seems that as the corneal epithelium matures, these cells are sequestered in the limbus.

Quantification of Retinal Nerve Fiber Layer Thickness in the Normal Subjects Using Optical Coherence Tomography

Optical coherence tomography is a new imaging technique analogous to ultrasound B scan that can provide cross sectional images of retina with approximately 10micrometer resolution. This study was designed to evaluate the quantification of nerve fiber layer [NFL] thickness in normal eyes using OCT. We studied 66 eyes of 66 subjects by conventional ophthalmoscopic physical examination, Humphrey central 30-2 visual fields, stereoscopic optic nerve head photography, retinal nerve fiber layer photography, HRT and OCT. Imaging with OCT was performed circumferentially around the optic nerve head with a circle diameter of 2.3mm & 3.4mm using an internal fixation technique. At a scan diameter of 2.3mm and 3.4mm, average, superior, inferior, nasal and temporal NFL thicknesses were 125.45 +/-19.05 micrometer, 150.33 +/-25.53micrometer, 154.55 +/-25.72 micrometer, 102.89 +/-29.13micrometer, and 92.65 +/-27.04micrometer and 109.02 +/-15.68 micrometer,135.53 +/-22.65 micrometer, 132.98 +/-20.19micrometer, 73.11 +/-26.85 micrometer and 89.70 +/-14.65 micrometer each. The NFL was thickest in the superior and inferior quadrants,thinnest in the nasal quadrant at a scan diameter of 2.3mm, and thinnest in the temporal quadrant at a scan diameter of 3.4 mm. In general the thickness for the 2.3 mm scans was greater than that for the 3.4mm scans.NFL thickness decreased significantly with age in the temporal quadrants [P<0.05]. At a scan diameter of 3.4 mm, NRA decreased significantly with decreased average NFL thickness and average NFL thickness decreased significantly with decreased disc area [P<0.05]. By direct investigation of the NFL with OCT, earlier diagnosis of glaucoma and earlier detection of glaucomatous progression can be made, before conventional signs such as visual field loss, cupping of the optic nerve head, and NFL defects are evident, thus allowing earlier treatment and reducing the damage.

Optic Disc Measurements with Topographic Scanning System

Quantitative analysis of the optic nerve head topography is important in diagnosis, differential diagnosis and follow-up of optic nerve diseases, especially in glaucoma. This study was undertaken to analyze the optic nerve head with confocal scanning laser ophthalmoscope(TopSSTM Software Version 2.2, LDT.Inc) and further to determine gender, age, refractive error and axial length-based on differences in the size and topography of the optic disc. One hundred normal human optic nerve heads of 100 subjects (42 men, 58 women, mean age 43.3+/-14.5 years) were evaluated. The men value of the parameters in TopSSTM were as follows : horizontal disc diameter 1.62+/-0.17mm, vertical disc diameter 1.77+/-0.24mm average disc diameter 1.71+/-0.15mm, disc area 2.31+/-0.43 mm2, cup area 1.01+/-0.50 mm2, horizontal cup to disc ratio 0.52+/-0.17, vertical cup to disc ratio 0.47+/-0.20, average cup to disc ratio 0.45+/-0.18, rim area 1.30+/-0.35 mm2. There were no significant correlations between these morphometric optic disc parameters and age, refractive error or axial length(p>0.05). However, male subjects had about 10% larger optic discs compared with female subjects. The optic disc size was well correlated with cup area and rim area (p<0.05).

The Blue Sclera in Osteogenesis Imperfecta

Osteogenesis imperfecta is relatively rare hereditary disease. It is characterized by frequent multiple bone fractures, spine scoliosis due to fragility of bone and is often associated with blue sclera, deafness and dentinogenesis imperfecta. Three-year-old male patient showed left tibia and fibula fractures and spine scoliosis with mild cortical bone thinning of tibia and fibula in radiologic study and blue sclera with family history of autosomal dominant inheritance pattern on ocular examination. He suffered 4 times lower leg fractures during the last 19 months. But, other features associated with osteogenesis imperfecta such as deafness or dentinogenesis imperfecta were not observed. The authors diagnosed osteogenesis imperfecta clinically and report this case with review of available literature.

The Correlation between Intraocular Pressure and Myopia in Children

While elevated intraocular pressure[IOP] is associated with myopia in adults, its potential influence on the growth of eyes in juveniles is controversial. To address this issue, an possible relation between IOP and refraction in children was sought. IOP and refractive state were measured in one hundred sixty-eight eyes of children. For data analysis, myopia was defined as a spherical equivalent of more than 1 diopter of myoia. We compared the intraocular pressure difference between myopia and non-myopia. There were eighty-seven eyes with myopic children and eighty-one with non-myopic children. The mean age was 10.08+/-3.12 years in myopic children and 7.94+/-3.31 years in non-myopic. The mean age of myopic children was older than non-myopic children. The mean spherical refractive error of all subjects was -1.98+/-2.47 diopter; -2.82+/-1.89 diopters, myopia, and 0.16+/-1.12diopters, non-myopia. The mean IOP of all subjects was 15.01+/-2.67mmHg ; 16.47+/-3.36mmHg, myopic, and 14.26+/-2.08mmHg, non-myopic[p<0.05]. These results indicate that IOP in children may be higher in myopic eyes than in non-myopic eyes. Whether IOP could contribute to the mechanisms causing the eye growth of childhood myopia requires further study.

The Frontalis Muscle Transposition in Severe Congenital Ptosis

The frontalis sling operation for the correction of severe congenital ptosis have been used, but this method is not entirely satisfactory in some cases due to longstanding lagophthalmos, lid lag, undercorrection. So authors have used the frontalis muscle transposition in 5 patient (6 eyes) in 1996 Febuary to July with satisfactory results. The frontalis sling operation was correction method by using foreign materials in severe ptosis patients with poor levator function, however, the operation method of frontalis transposition was correction method by using patients` own muscle, so more physiologic than frontalis sling operation. And postoperative compliscations including lagophthalmos, undercorrection were less developed in patients were operated by method of frontalis muscle transposition. Therefore, the frontalis muscle transposition need careful technique anatomically but more physiological operation method than frontalis sling operation in severe congenital ptosis patients with good frontalis muscle function.

The Relationship between Open Angle Glaucoma and Refractive Errors

Among many suggestive risk factors for the development of open angle glaucoma, myopia is a common clinical entitiy and seems to be increasing today. The authors analysed the prevalence of myopia in patients with open angle glaucoma and compared with normal population of similar age. The results were as follows 1. Fifty-one eyes(82.3%) with POAG, seventy eyes(74.5%) with LTG and thirty-five eyes(87.5%) with OHT were myopia. 2. The percentage of myopia in eyes with POAG, LTG and OHT was greater than that of reported in a normal population of similar age(32.2%). Especially, the percentage of myopia greater than -3.0 diopter among myopias was 52.9% in POAG, 30.0% in LTG, 48.6% in OHT and only 17.3% in normal control groups.

Results of Combined Cataract and Glaucoma Surgery with Mitomycin C

To evaluate the results for intraocular pressure (IOP), visual acuity and postoperative complications, we conducted a retrospective review of the records of 29 consecutive cases who had combined cataract and glaucoma surgery with mitomycin C (0.2mg/ml) in patients with coexisting cataract and glaucoma. The mean follow-up period was 6.8 +/- 1.8 months. The mean preoperative lOP was 26.3 +/- 9.1mmHg(range, 11-44mmHg), which decreased by mean 12.1mmHg to a mean postoperative IOP of 14.2 +/- 3.4mmHg(range,7-22mmHg) as measured at the last follow-up. At the last follow-up, 21 eyes(72.4%) had IOPs of 21mmHg or less without glaucoma medications as complete sucess. The mean preoperative number of antiglaucoma medication was 2.4 +/- 1.0 (range, 1-4), which decrease to a mean number of antiglaucoma medication of 0.4 +/- 0.7 (range, 0-2) at the last follow-up. All patients were using fewer medications at last follow-up than preoperatively. Twenty two eyes (75.9%) had a best-corrected visual acuity of 0.5 or better at the last follow-up. Last follow-up best-corrected visual acuity was better than the preoperative best-corrected visual acuity for all patients. Six eyes (20.7%) had fibrinous uveitis as the most common postoperative complication, and other complications were hyphema, wound leak and cystoid macular edema etc. The glaucoma triple procedure with adjunctive mitomycin C(0.2mg/ml) appears to be a safe and effective surgical technique for treating patients with coexisting cataract and glaucoma.

The Effect of Topically Applied Sodium-hyaluronic acid(Na-HA) on Corneal Epithelial Healing

To evaluate the effect of Na-hyaluronic acid (Na-HA) on corneal epithelial wound healing, twenty admitted patients (twenty-four eyes) with corneal epithelial abrasion were randomly divided into 2 groups. 1% Na-HA was given 4 times daily to 12 treated eyes while 12 control cases received antibiotic ointment therapy. Epithelial defect area was photodocumented by 6-12 hours interval and individual healing rates were calculated by linear regression analysis. The healing rate of 1% Na-HA treated cornea was 1.02 +/- 0.26mm2/hour and that of the control eyes was 0.67 +/- 0.19 mm/hour(p<0.05). The result suggests that topically applied Na-HA enhances epithelial re~surfacing when compared to the antibiotics ointment.

A Correlation between The Change in The Blood Pressure and Na+ - K+ - ATPase Activity in Spontaneous Hypertensive Rat

The maintenance of balance between water and electrolyte is essential for keeping the lens transparent. The outflow of the Na+ ion from the membrane and inflow of the K+ ion both of which are sustained by the Na+ - K+ - ATPase, play an important role in maintaining this balance. In this study, by comparing the lens Na+ - K+ - ATPase activity in Spontaneous Hypertensive Rat(SHR) and Sprague-Dawley Rat (SDR), we determined the significance of increase in blood pressure and the change in the enzyme activity after control of blood pressure by administration of Inderal, an anti-hypertensive drug. The Na+ - K+ - ATPase activity was significantly lowered(P<0.01) in the lens of SHR compared to that of SDR. The longer the anti-hypertensive drug was administered and then controlled the blood pressure, the higher the recovery rate of the lowered Na+ - K+ - ATPase activity of SHR, rising up to about 50%. From the results of this study, it is suggested that the activity of lens Na+ - K+ - ATPase may be reversibly recovered after blood pressure control, and that the pathogenesis of high blood pressure-associated cataract may be partially prevented by controlling the blood pressure.

A Clinical Study of Retinopathy of Prematurity

One hundred premature infants with birth weight less than 2000 gm or with gestational ages less than 37 weeks who admitted to Ewha Womans University from January 1991 to May 1993 were examined by indirect ophthalmoscope. We analysed the incidence and the risk factors of retinopathy. The results were as follows: 1. Twenty one infants(21.0%) were diagnosed as retinopathy of prematurity. Among them, six infants(28.6%) presented stage 1, three infants(14.3%) at stage 2, twelve infants(57.1%) at stage 3. 2. Male patients were 11(52.4%) and female patients were 10(47.6%). There was no significant difference in incidence between male and female. 3. The incidence of retinopathy of prematurity increased with low birth weight(<1500 gm), small gestational age(33 weeks) and oxygen administration. 4. The risk factors associated with oxygen therapy besides the duration of oxygen exposure were hyperoxia, hypoxia, hypercarbia, hypocarbia and acidosis. 5. The retinopathy of prematurity was initially diagnosed at 5.6 weeks in average(36.3 weeks by postconceptional age). The onset of retinopathy of prematurity was timed according to postconceptional age rather than chronologie age since birth. 6. Other possible associated risk factors were spontaneous premature rupture of membrane, sepsis, hyaline membrane disease, neonatal hyperbilirubinemia, transfusion and low 5-minute Apgar scores.

Surgical Correction of Involutional Entropion

The pathophysiologic changes that lead to involutional entropion are Weakness of the lower lid retractors, Upward migration of preseptal orbicularis over pretarsal orbicularis and forward rotation of lower border of tarsal plate, Horizontal lid laxity from involutional changes of medial and lateral canthal ligament and Enophthalmos from atrophy of the orbital fat with age. In the correction of involutional entropion, the first three factors must be considered for adequate correction. Hsu and Lieu reported Pretarsal orbucularis oculi muscle fixation method for the correction of involutional entropion. Authors performed this method in the 20 patients with involutional entropion of thirty-one eyelids and the results were sucessful.

Interrelationship between Refractive Error and Angle kappa

Distributions of angle kappa and of cycloplegic refraction and their association were studied. The subjects were 282 nonstrabismic Korean children, aged from 6 years to 11 years. who visited Ewha Women University Hospital from December 1990 to March 1991. The angle kappa was measured by major amblyoscope, and refraction was done under the cycloplegic state. The results were as follows: The frequency of angle kappa was positive. negative and 0 degree in decreasing order. The average values of refractive error and angle kappa were -1.03 +/- 2.20 degrees dipter and +1 34 +/- 1.33 degrees. The average values of angle kappa for hypermetropia, emmettopia and myopia were +2.52 +/- 0.81 degrees, +1.71 +/- 1.03 degrees and +0.90 +/- 1.37 degrees. And these values were significantly different from each other.

A Study on the Heterophoria in Emmetropia and Ametropia

The purpose of this study was to examine the heterophoria in emmetropia and ametropia. The subjects were 337 healthy men and women between the age of 20-41 years. In 337 cases, Emmetropia were 135 cases, Ametropia were 202 cases. The entire group was tested for heterophoria with synoptophore. In the ametropia, this test was performed before and after correction of refractive error with glasses. The results were as follows: 1. The incidence of heterophoria was 84.4% in emmertropia, 89.2% in myopia and 91.4% in hyperopia. 2. Exophoria was most common in myopia. But in emmetropia and hyperopia, there was no significant difference between the incidence of exophoria and esophoria. The incidence of hyperphoria and cyclophoria was not significantly different between emmetropia and ametropia. 3. In the ametropia, the size of heterophoria was slightly decreased after correction, but the difference was not significant (p>0.05). 4. There was no correlation between the amount of refractive error and the size of heterophoria (p>0.05).

Congenital Aniridia in a Family for Three Generations

Aniridia is a congenital, often hereditary, usually bilateral absence of iris in whole or in part. And aniridia occurs mainly as an autosomal dominant condition with almost complete penetrance. In the usual phenotype, aniridia is associated with nystagmus, foveal and optic nerve hypoplasia, corneal pannus, cataract, secondary glaucoma and strabismus. The author experienced 4 cases of aniridia in a family for three generations. So the author reports these cases with the review of literathure.

The Significance of Clinical Symptoms in Dry Eye Patients and Statistical Analysis of the Patiants

From April 1 to July 30, 1989, we studied 188 subjects(male 25, female 163) with suspected dry eye based on their clinical symptoms and their response to conventional treatment with artificial tear. Schirmer Test and Tear break-up time measurement(B.U.T.) were performed on each patient. There have been many reports that Schirmer test and B.U.T. measurement can be influenced by many enviromental factors and testing methods so the question of their relative value has not yet been sloved. the purpose of this study was to evaluate the importance of clinical symptoms and signs in diagnosing dry eye. Demographic aspect of dry eye patients in Korea was also analysed. The results were as follows: 1. The sex distribution was 163 females(87%) and 25 males(13%). There were absolutely more females than males. 2. The ages ranged from 15 to 83 years old. The peak age was from 41 to 50 years(29%). 3. Among 163 female patients, the majority 103(63%) were menopausal and postmenopausal females. 4. Among major chief clinical complaints, foreign body sensation showed the highest frequency with 67 patients(35%). 5. Major aggravating factor of the disese was prolonged use of eye which showed highest frequency with 122 patients(65%). 6. There were no statistically significant differences in the mean value of BU.T. and Schirmer test between right left eye(p<0.05). 7. In the majority of the cases 153(82%) the B.U.T. and Schirmer test value were 8 sec and 8mm or below respectively.

A Case of Ethmoid Mucocele

Mucocele is a chronic, expansile, cyst-like lesion of the paranasaI sinuses. They contain sterile mucoid material and are lined by mucosa of the affected cavity. Mucocele develops when drainage of normal sinus secretion is obstructed usually by scarring, inflammation, trauma, and tumor. Most of the mucocele are found in the frontal sinus and anterior ethmoid sinus. They may present ophthalmic manifestations such as exophthalmos, displacement of the eye, and limitation of eyeball movement. We experienced a case of left ethmoid mucocele in a 48-year old man. Histologic examination confirmed the mass to be mucocele of the ethmoid Sinus.