The Abnormalities of Retinal Arteriole in Atherothrombotic Ischemic Stroke Patients Representing the Changes of Cerebral Vasculature Indirectly

PURPOSE: Retinal blood vessels and cerebral small vessels possess similar characteristics anatomically, physiologically and embryologically. We studied the availability of abnormal fundus findings of patients who had an atherothrombotic ischemic stroke and who have the risk factors. METHODS: Fundus photographs and brain images were taken in patients who had a first-ever symptomatic ischemic stroke of large artery atherosclerosis (LAA) or small vessel occlusion (SVO) from March 2004 to February 2005. We analyzed the association between fundus abnormalities and ischemic stroke subtypes. RESULTS: Based on brain MRI and MRA, a total of 47 patients were classified into SVO and LAA groups. The SVO group consisted of 27 patients (mean age: 69.7 years), and the LAA group consisted of 20 patients (mean age: 65.4 years). The control group comprised 15 patients (mean age: 64.9 years). The baseline characteristics were similar among the three groups. The severity of the retinal arteriolar narrowing and sclerosis were associated with hypertension. Compared to the control group, both the SVO and LAA groups showed more severe arteriolar sclerosis, the SVO group showed more severe arteriolar narrowing and the LAA group showed more frequent AV crossing and retinal exudate. CONCLUSIONS: Retinal arteriolar abnormalities such as arteriolar narrowing and sclerosis are more severe in atherothrombotic ischemic stroke patients. Indirectly, retinal microvascular changes may indicate the status of the cerebral vasculature. Thus, analysis of fundus findings is useful for predicting an atherothrombotic ischemic stroke and planning follow-up examinations.

The Effect of the Amniotic Membrane and Methocel (R) on the Postoperative Adhesion after Strabismus Surgery

PURPOSE: To evaluate the effect of amniotic membrane and additional use of 2% methylcellulose(Methocel(R)) in reducing the postoperative adhesions following strabismus surgery. METHODS: Twenty white rabbits (40 eyes) were divided into 4 groups: control group C (12 eyes), trial group A (12 eyes), trial group B (12 eyes), and normal group N (4 eyes). In group C, the superior rectus was detached and scleral scratching was done to provoke a fibrotic reaction, and then, the superior rectus was reattached to the original insertion site. In group A, the above procedure was done and in addition, the superior rectus was covered with two-folded amniotic membrane. In group B, the same procedure was done as in group A and in addition, Methocel(R) was coated between the muscle and adjacent tissues. Eight weeks later, we divided each group into two subgroups. In one group, we examined the degree of adhesion by the blunt dissection between the muscle and adjacent tissues, and in the other group, the histologic findings with a light microscope between the muscle and adjacent tissues. RESULTS: The adhesion degree on the blunt dissection and histologic examination was significantly reduced in groups A and B. But no statistically significant difference between groups A and B was shown in the postoperative adhesion. CONCLUSIONS: From these findings, it is expected that the use of amniotic membrane may reduce the postoperative adhesion after strabismus surgery and theadditional use of Methocel(R) may not be useful.

Amniotic Membrane Transplantation for the Conjunctival Necrosis after Scleral Gra t in the Enucleated Eye: 1 Case Report

The amniotic membrane has some characteristics. First, it does not express the human leukocyte antigens, and therefore immunologic rejection is not a concern. Second, it can be obtained easily and sufficiently. Third, because it has antimicrobial properties, transplantation of the amniotic membrane has fewer risks of post-operative infection. So it is under research for the amniotic membrane transplantation in cases of sterile corneal ulcer, pterygium excision,severe chemical and thermal corneal burns, ocular surface defects, conjunctival surface reconstruction after removal of large conjunctival lesions. We have experienced a good result of amniotic membrane transplantation for the conjunctival defect resulting from conjunctival necrosis, in enucleated eye having undergone scleral graft for scleral necrosis. Therefore, we report this case with a review of the literature.

A Case of Cyclic Esotropia Cured by Botulinum Toxin Injection

Cyclic strabismus is a rare entity, which is characterized by alternating periods of strabismus and orthophoria.The mechanism is not clear but seems to be related to the biological clock. Cyclic esotropia is the most common type. On "strabismic"days,a large-angle esotropia will appear, and the binocular vision is impaired. On "straight"days, orthophoria or microstrabismus will appear and no abnor-mal binocular vision is observed. As a treatment, surgery based on the full amount of heterotropia on the strabismic day,has been successful, but treatment by chemodenervation ith botulinum toxin has not been reported yet. Authors experienced the cyclic esotropia following head trauma by a traffic accident in a 3-year-old boy and tried the injection of botulinum toxin on both medial rectus muscles as a treatment. In one-year follow-up observation, the cyclic pattern and esodeviation has disappeared.