Clinical Availability of Ophthalmic Tests and PET Neuroimaging in Children with Cortical Visual Impairment

PURPOSE: We performed this study to determine if ophthalmic tests and positron-emission tomography (PET) would have any useful role in the investigation of cortical visual impairment (CVI) in children. METHODS: Ophthalmic tests were performed in children with CVI. After children with CVI and normal volunteers were examined using PET, PET images were transformed spatially on template images using Statistical Parametric Mapping 99 for analysis. The PET images of the CVI patients were compared with those of the normal group to display pixels with significantly decreased metabolism. Glucose metabolism in each patient was compared to that of the normal group and the number of pixels with decreased metabolism in each lobe was counted for analysis. RESULTS: Nine children with CVI showed variable degree of visual acuity. There were two patients with strabismus and one patient with latent nystagmus. In CVI group (n=5), there was a decrease of glucose metabolism in comparison with that of normal group (n=22) in occipital lobe as well as other areas, and the degree of decrease varied widely. The extent of the areas with decreased glucose metabolism in the occipital lobe of each patient ranged widely from 4% to 59%. CONCLUSIONS: The cerebral glucose metabolism was decreased with a variable degree in children with CVI. This result suggests that PET may be helpful in the diagnosis of children with CVI.

Preretinal Neovascularization by Laser-induced Thrombosis in Albino Rats and Inhibition of Neovascularization by Genistein

PURPOSE: To determine the effect of genistein, an inhibitor of protein tyrosine kinase, on preretinal neovascularization through the quantification of retinal neovascularization using image analyzer in an experimental rat model. METHODS: In 36 eyes of 36 rats, retinal vein occlusion was induced by photodynamic therapy with an argon green laser and systemic injection of rose bengal (40 mg/kg). The development and progression of retinal neovascularization was followed weekly by fluorescein angiography. Seven rats were sacrificed each week, after which two eyes were prepared with H and E staining for histologic examination, and five were prepared as a control group using ADPase staining for neovascularization analysis. In the remaining fifteen eyes, retinal vein occlusion was also induced using the same method. Immediately after vein occlusion, 4.0 mg of genistein dissolved in dimethyl sulfoxide (DMSO) was injected intraperitoneally twice a day for the first 7 days. Five rats were sacrificed each week and stained with ADPase. After ADPase staining, those samples with evidence of neovascularization were quantified using an image analyzer. RESULTS: No retinal neovasularizaion was found at the end of the first week. The size of retinal neovascularization for the five eyes sacrificed at the end of week 2 and 3 were 6.53+/-2.11 mm2 and 3.77+/-3.51 mm2 in the control group, and 2.22+/-1.01 mm2 and 1.64+/-0.88 mm2 in the genistein treatment group, respectively. Retinal neovascularization was successfully suppressed until two weeks after laser treatment by genistein in this rat neovascularization model. CONCLUSIONS: Genistein may be a useful treatment modality to suppress retinal neovascularization complicated with retinal ischemic injury.

The Results of Operation of Total Cataract

No Abstract Available.

Surgical treatment of subretinal neovascular membrane

The visual results of laser photocoagulation for subfoveal choroidal neovascular membrane (CNVM) has not always been satisfactory. The surgical removal of the neovascular membrane may be another treatment option. To investigate the prognosis and risk factors of this surgery, we analyzed the results of surgical removal of subfoveal CNVM (23 eyes), subfoveal hemorrhage with CNVM (6 eyes), and subfoveal hemorrhage alone (6 eyes). The mean follow-up period was 17.7 months (range 2 to 47 months). The mean preoperative membrane size was 0.89 disc diameter and the mean postoperative retinal pigment epithelial (RPE) defect size was 1.33 disc diameter. Visual improvement was observed in 13 out of the 23 eyes (56.5%) with sufoveal CNVM, four out of the six eyes (66.6%) with subretinal hemorrhage and CNVM, and five out of the six eyes (83.3%) with subretinal hemorrhage only. The visual outcome of subfoveal CNVM surgery was related to the presence of a subfoveal RPE defect (p = 0.005) rather than to the size of the RPE defect. No recurrence of neovascular membrane was observed during the follow up period. In conclusion, surgical removal may be a good alternative treatment for subfoveal CNVM.

The Risk Factors of Silicone Oil Induced Secondary Glaucoma

Intravitreal silicone oil injection is useful to manage the complicated retinal detachment. However, many comlications including secondary glaucoma can occur followin gsilicone oil injection. We performed this study to investigate the incidence and risk factors of silicone oil induced secondary glaucoma. The medica records of 213 eyes of 210 consecutive patients who underwent pars plana vitrectomy and silicone oil injection between January 1990 and June 1997, were reviewed retrospectivel. Fifty five of 213 eyes(25.8%) developed secondary glaucoma. The mean follow-up period was 33.4 months. The mean amount of injected silicone oil was 5.0+/-1.0ml, and 33.4 the mean numbers of operation prior to the silicone oil injection was 2.3. 65.5% of secondary glaucoma was developed within 1 year of silicone oil injection. High preoperative intraocular pressure(IOP) (p=0.004), high myopia(p=0.015) and presence of silicone oil in anterior chamber(p=0.004) increased the incidence of secondary glaucoma significantly. In conclusion, patients who have high preoperative IOP, high myopia and silicone oil in anterior chamber must be carefully followed after silicone oil injection due to high incidence of secondary glaucoma, especially during the first 1 year.

The Etiology and Clinical Feature of the Third, Fourth, and Sixth Cranial Nerve Palsy

40 patients who were diagnosed as the palsy of the third, fourth and sixth cranial nerve at Seoul national university hospital, were evaluated to reveal the etiology and clinical feature. The palsy of sixth cranial nerve is most common, and those of third and fourth cranial nerve followed it. Trauma was the most common cause of the palsy of the third, fourth, and sixth cranial nerve. Most of the palsy of the third cranial nerve involved both upper and lower branch, and aberrant regeneration was observed at 8 cases and its major cause was also trauma. The palsy of sixth cranial nerve was more frequently accompanied other cranial nerve palsy than those of the other two. Average recovery rate was 44.8% and, that of the sixth cranial nerve was higher than those of the other two.