The Efficacy of Brinzolamide 1%/Brimonidine 0.2% Fixed Combination in Normal Tension Glaucoma

PURPOSE: To evaluate the efficacy and safety of brinzolamide 1%/brimonidine 0.2% fixed combination (BBFC) in normal tension glaucoma (NTG) patients. METHODS: This prospective study included patients treated with brinzolamide 1% monotherapy, brimonidine 0.2% monotherapy or brinzolamide 1% and brimonidine 0.2% concomitant therapy, as well as newly diagnosed NTG patients. The enrolled patients who used brinzolamide 1% or brimonidine 0.2% switched to BBFC and newly diagnosed NTG patients were treated with BBFC. The patients receiving brinzolamide 1% or brimonidine 0.2% monotherapy or brinzolamide 1% and brimonidine 0.2% concomitant therapy switched antiglaucoma drugs to BBFC. Newly diagnosed NTG patients used BBFC as the first therapy. The study consisted of 1 screening/baseline visit and 3 follow-up visits conducted after 1, 4, 8, 12 and 24 weeks of treatment. Intraocular pressure (IOP), mean deviation value and adverse drug reactions were evaluated before treatment and after treatment with BBFC. RESULTS: The mean IOP in the brinzolamide 1% monotherapy group was 13.5 ± 1.6 mm Hg and the mean IOP after switched from brinzolamide 1% monotherapy to BBFC was 12.1 ± 1.5 mm Hg. The mean IOP in the brimonidine 0.2% monotherapy group was 14.2 ± 1.3 mm Hg and the mean IOP after switched from brimonidine 0.2% monotherapy to BBFC was 11.7 ± 1.5 mm Hg. The mean IOP was 11.9 ± 2.1 mm Hg in the brinzolamide 1% and brimonidine 0.2% concomitant therapy group and the mean IOP after switched from brinzolamide 1% and brimonidine 0.2% concomitant therapy to BBFC was 12.0 ± 1.1 mm Hg. The mean IOP and reduction rate were 10.7 ± 2.1 mm Hg and 35.5%, respectively,in the newly diagnosed NTG patients treated with BBFC. There was no serious adverse drug reaction causing ocular damage. CONCLUSIONS: BBFC provides a significant IOP reduction and is a safe antiglaucoma medication for NTG patients.

A Case of Optic Neuropathy Associated with Methyl Bromide Intoxication

PURPOSE: In this study, a case of toxic encephalopathy and optic neuropathy due to methyl bromide poisoning is reported. CASE SUMMARY: A 31-year-old male presented with dysarthria, gait disturbance and bilateral visual impairment. He was treated with intravenous methylprednisolone for bilateral optic neuritis 1 year prior. He previously worked in a fumigation warehouse and was exposed to methyl bromide in the past 3 years. His corrected visual acuity was 20/30 in both eyes. The patient had reduced color vision and enlarged central scotoma in both eyes. His mentality was alert but exhibited slow response, ataxia and dysarthria. Brain magnetic resonance imaging (MRI) revealed high signals in the brainstem, cerebellum and midbrain. His serum and urine methyl bromide concentrations were significantly elevated. The patient was treated with intravenous methylprednisolone 1.0 g/day for 5 days. MRI showed resolution of the multiple brain lesions observed previously. Ten days after steroid therapy, his visual acuity was 20/20 in both eyes and his neurologic manifestations were completely recovered at 2 months after treatment. CONCLUSIONS: Taking a detailed occupational history is necessary in patients with optic neuropathy. The probability of toxic optic neuropathy should be considered when patients are exposed to toxic materials.

Preoperative Factors Affecting the Visual Outcome after Vitrectomy in Rhegmatogenous Retinal Detachment

PURPOSE: To investigate the preoperative factors affecting the visual outcome after a vitrectomy in a rhegmatogenous retinal detachment (RRD). METHODS: A retrospective study of 79 eyes was carried out. The 41 eyes were macula-off RRD (group I), the 38 eyes were macula-on RRD (group II). The preoperative factors examined in this study included the preoperative best corrected visual acuity (BCVA), age, the duration of macular detachment, the extent of the detached retina, the delay of operation. The correlation between these factors and the postoperative 6 months BCVA were investigated. RESULTS: In group I, preoperative BCVA (r = 0.313, p = 0.037) and preoperative retinal detachment (RD) extent (r = 0.483, p = 0.001) were significantly correlated with postoperative 6 months BCVA. In group II, preoperative BCVA and preoperative RD extent were not significantly correlated with postoperative 6 months BCVA. Regardless of including macula, the patient's age, duration of symptom and delay of operation after clinic visit were not affected to the visual outcome. Patients with symptom duration of 7 days or less achieved better final BCVA (0.36 ± 0.45 log MAR, n = 29) than patients with longer symptom duration (0.79 ± 0.55 log MAR, n = 16) (p = 0.008). CONCLUSIONS: After vitrectomy for macula-off RRD, the factors related to favorable visual outcome were the better preoperative BCVA, the less extent of the detached retina. And surgical repair within 7 days of the symptom onset yielded better visual outcomes. Otherwise, in macula-on RRD, preoperative BCVA, age, the duration of retinal detachment, the extent of the detached retina, the delay of operation did not impact on visual outcome.

Tumor Angiogenesis Correlates with Prognosis in Patients with Stage 3 Gastric Cancer / 대한암학회지

PURPOSE: Several studies suggest that tumor angiogenesis is a significant prognostic factor in carcinoma of the breast, lung, prostate, oral cavity, and colon. We assessed whether intensity of tumor angiogenesis, as measured by microvessel counts in histologic sections, correlates with prognosis in patients with stage III gastric cancer. MATERIALS AND METHODS: Paraffin-embedded sections from 49 patients (23 stage IIla, 26 stage IIIb) with primary gastric cancer that had been completely removed were analyzed for angiogenesis. Vessels were stained with anti-factor VIII polyclonal antibody, and areas with the most discrete microvessels were counted in a 200X field. RESULTS: Patients with stage IIIa gastric cancer had fewer microvessels than those with stage IIIb gastric cancer (32.8+-14.5 vs. 40.3+-16.1, P=0.106). The mean microvessel count from patients who were alive were significantly lower than that from patients who had died at the time of follow-up (24.8+-10.0 vs. 42.9+- 14.5, P=O.OOO). The 5-year survival rate of patients with count less than 33 microvessels was higher than that of patients with count more than 33 microvessels (59.9% vs. 11.6%, P= 0.000). On multivariate analysis by Cox proportional hazards model, the microvessel count was a significant prognostic factor of stage III gastric cancer. CONCLUSION: Tumor angiogenesis assessed by microvessel count may be a significant prognostic factor of stage III gastric cancer and may prove valuable in selecting patients with stage III gastric cancer for aggressive adjuvant therapy and closer postoperative follow-up.