Phacoemulsification versus Laser Peripheral Iridotomy in Early Treatment of Acute Primary Angle-Closure Glaucoma

PURPOSE: We compared the outcomes of laser iridotomy and primary phacoemulsification when treating acute angle-closure glaucoma. METHODS: This study was conducted with 61 patients diagnosed with acute angle closure glaucoma from January, 2005 to January, 2015. The patients received either laser iridotomy or primary phacoemulsification. The age and gender of each patient, differences of intraocular pressure (IOP) before and after treatment, visual acuity, need for IOP lowering agents and complications were analyzed retrospectively at 1-day, 1-month, 6-month and 12-month after the treatment. Patients who received laser iridotomy with phacoemulsification or trabeculectomy were excluded from this study. Additionally, we included only cases in which treatments were given within 3 days after the onset of symptom. RESULTS: Among the 61 patients, 45 patients received laser iridotomy and 16 patients received primary phacoemulsification. One day after the treatment the laser iridotomy group showed better outcome in their visual acuity (log MAR 0.62 +/- 0.51; p = 0.048). At 6-month postoperatively, the primary phacoemulsification group showed better visual acuity (log MAR 0.07 +/- 0.15; p = 0.013). However, at 12-month postoperatively, the visual acuities were not significantly different between the 2 groups. Regarding IOP, at postoperative 1-month, the group of primary phacoemulsification shows significantly lower IOP (9.5 +/- 1.3 mm Hg), compared with the group of laser iridotomy. A significant difference was observed in the number of IOP lowering agents that patients at 12 month after the treatment. There were no severe complications in either group. CONCLUSIONS: Following the initial treatment of acute angle-closure glaucoma, the primary phacoemulsification showed no significant differences in postoperative visual acuity, IOP and complications compared to the outcomes of laser iridotomy. Additionally, the need for IOP lowering agents was less in the primary phacoemulsification groups at 1 year after the operation.

Measuring Blood Viscosity in Normal Tension Glaucoma Patients

PURPOSE: Non-intraocular pressure (IOP) factors such as vascular factors have been identified as contributing to normal tension glaucoma. However, there is not an established range of haemorheological factors considered normal, nor are there standardized tests. In this study, we investigated differences in blood viscosity and haemorheological parameters between patients with normal tension glaucoma (NTG) and normal controls using a new instrument called the BVD-RO1 (BIO-VISCO. Inc., Jeonju, Korea). METHODS: Twenty patients with NTG and 20 age-matched normal controls were included in the study. Haemorheological parameters of the venous blood samples, including blood viscosity at the shear rates of 300 (high shear rate) and 1 (low shear rate) s-1 were measured using an automated scanning capillary tube viscometer. RESULTS: More hematocrit concentration was detected in the NTG group than in the control group (p < 0.05). Furthermore, higher blood viscosities at the high (p < 0.01) and low (p < 0.01) shear rates were found in the NTG group. CONCLUSIONS: The NTG patients differed in blood viscosity with the control group. This may signify the importance of hemodynamic factors in the pathogenesis of NTG.

Steroid-Induced Ocular Hypertension Model in the Mice

PURPOSE: To determine whether rat eyes develop increases in intraocular pressure (IOP) in response to a topically applied corticosteroid and to investigate the relationship between ocular hypertension and apoptosis of retinal ganglion cells. METHODS: IOP was monitored by rebound tonometry in a group of 10 rats that received topically administered dexamethasone in both eyes (experimental) and in another group of 5 rats that received artificial tears (control) three times daily for 4 weeks after the establishment of baseline IOP values. Only eyes that increased by more than 50% compared with the basal IOP were administered once per day for 5 weeks. After 8 weeks, selective immunofluorescence stain for retinal ganglion cells and terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) stain were conducted. RESULTS: Among 20 experimental eyes, 11 eyes (55%) showed a greater than 50% increase in IOP compared with basal IOP. After 8 weeks, the mean IOPs for the experimental and control groups were 11.8 +/- 1.4 mm Hg and 18.5 +/- 1.0 mm Hg, respectively (p < 0.01). The counts of central retinal ganglion cells (RGCs) were 2718 +/- 240 and 2612 +/- 443, respectively (p = 0.294). The results of the TUNEL stain also showed no differences. CONCLUSIONS: Rat eyes exhibit a steroid-induced ocular hypertensive response with no local complications. However, maintaining ocular hypertension increased by 50% for two months was not enough to detect changes in RGCs.

Comparison of Herpes Zoster Ophthalmicus in Patients 60 Years Older Versus Younger than 60 Years

PURPOSE: To analyze and compare the clinical characteristics of patients with herpes zoster ophthalmicus (HZO) by age groups on the basis of the age of 60. METHODS: Medical records of patients with HZO who visited Chonbuk National University Hospital from February 1, 2002 to February 28, 2011 were reviewed. The patients with follow-up of three months or more were divided into two groups: patients under 60 and patients with 60 years old and over. The clinical characteristics between two groups were examined through the analysis of their medical records. RESULTS: Among a total of 63 patients, 29 patients (46%) were under 60 years old, and 34 patients (54%) were 60 years old and over. Incidence of HZO highest in the sixties. The sex and intrusion of each group showed no difference. Younger patients had a higher incidence of pseudodendrite by HZO (86.2% vs. 58.8%, p = 0.014) compared with older patients who showed a higher incidence of post herpetic neuralgia (13.8% vs. 35.3%, p = 0.046). As patients showed Hutchinson's sign, they often had more ocular complications such as pseudodendrite (100% vs. 64.7%, p < 0.05), uveitis (41.7% vs. 7.8%, p = 0.04), and conjunctivitis (100% vs. 90.2%, p = 0.02). CONCLUSIONS: Herpes zoster ophthalmicus shows different clinical characteristics according to patients' age and requires appropriate treatment. Especially elderly patients showing Hutchinson's sign should be treated early and aggressively enough.

Long Term Effect of Double Silicone Tube Intubation for Acquired Nasolacrimal Duct Obstruction

PURPOSE: To evaluate the long term effectiveness of double silicone tube intubation in the treatment of acquired nasolacrimal duct (NLD) obstruction. METHODS: The authors treated 68 eyes of 40 patients with acquired NLD obstruction. The resolution of preoperative symptoms and signs of NLD obstruction was evaluated 18 months after the operation. RESULTS: The mean age of patients was 64.7 years and the mean follow-up period was 24.91 months. The symptoms and signs of NLD obstruction were improved in 85.29% of the patients. The partially obstructed group showed a higher success rate (89.29%) than the completely obstructed group (50.0%). A prolapse of silicone tubes to the ocular side was observed in 2 eyes, and 2 eyes had inflammatory signs after the procedure. CONCLUSIONS: Double silicone tube intubation is an effective primary therapy with NLD obstruction, especially for patiensts with simple partially obstructed NLD instead of dacryocystorhinostomy.

A Case of Achromobacter Xylosoxidans Keratitis

PURPOSE: To report a case of corneal ulcer caused by Achromobacter xylosoxidans in a farmer. CASE SUMMARY: A previously healthy 68-year-old man presented with unilateral redness and irritation after his eye was grazed by a cow's tail. The patient had previously been treated in a local clinic for four days without improvement. Bacterial staining, culture, and an antibiotic sensitivity test were performed from a corneal scrape. The cultures revealed growth of A. xylosoxidans. The patient was treated with moxifloxacin and ceftazidime eyedrops. After three months of treatment, the infection was resolved with mild scarring. CONCLUSIONS: Although it is a rare pathogen, A. xylosoxidans should be considered as a potential pathogen in patients presenting with corneal ulceration due to trauma from an object contaminated by soil or animal feces and having a slowly progressive disease and localized infiltrate but showing Gram-negative bacilli on smear examination.