Analysis of Serum Homocysteine and Risk of Coronary Heart Disease in Patients with Pseudoexfoliation Syndrome

PURPOSE: To investigate levels of serum homocysteine in patients with pseudoexfoliation syndrome and the association between serum homocysteine levels and risk of coronary heart disease. METHODS: From March 2013 to September 2013, 37 patients with pseudoexfoliation syndrome and 59 age-matched patients (control group) were enrolled in this prospective study. Serum homocysteine levels were compared between the 2 groups. We compared the estimated 10-year risk of coronary heart disease based on Framingham risk score between the 2 groups. Additionally, we analyzed correlations between risk of coronary heart disease and serum homocysteine levels. RESULTS: The mean homocysteine level of patients with pseudoexfoliation syndrome was significantly higher than the control group (13.3 ± 6.8 µmol/L vs. 10.0 ± 5.2 µmol/L, p = 0.009). The rate of high risk defined as a 10-year coronary heart disease risk >20% in the patients with pseudoexfoliation syndrome was significantly higher than in the control group (21.4% vs. 4.4%, p = 0.048). Correlation between serum homocysteine levels and estimated 10-year risk of coronary heart disease was statistically significant (r = 0.578, p < 0.001). CONCLUSIONS: Hyperhomocysteinemia and high risk of coronary heart disease were observed in patients with pseudoexfoliation syndrome. Therefore, we suggest efforts to prevent coronary heart disease in pseudoexfoliation syndrome patients with hyperhomocysteinemia are necessary.

Effects of Temporary Amniotic Membrane Patch after Surgical Excision of Primary Pterygium

PURPOSE: To investigate the clinical results, recurrence rates, and recurrence-related risk factors of temporary amniotic membrane patch (TAMP) after excision of primary pterygium. METHODS: Recurrence grade was evaluated for 73 eyes with a mean follow-up of 15.5 months (range 9 to 56 months). Surgical results were classified into surgical success (G0/G1), conjunctival recurrence (G2), and corneal recurrence (G3). Recurrence rates were analyzed based on gender, age, Tan's preoperative grading system, horizontal and vertical length of the preoperative pterygium, the corneal involvement size of the preoperative pterygium, planned or unplanned removal of amniotic membrane, and epithelial healing time. Using Kaplan-Meier survival analysis, the cumulative proportion of integrated G0/G1 was evaluated. RESULTS: In the postoperative grading, 58 (79.5%) and 9 (12.3%) eyes were graded as clinically recurrence-free G0 and G1, respectively; 4 (5.5%) and 2 (2.7%) eyes were graded as clinically recurrence-occurred G2 and G3, respectively. The cumulative proportion of integrated recurrence-free G0/G1 at 24 months after surgery was 0.83 +/- 0.08. T3 of Tan's preoperative grading system was identified as the only risk factor for recurrence above G1 through multivariate logistic regression analysis (p = 0.02). CONCLUSIONS: The recurrence rate of the present TAMP study showed better results in comparison with 9.1 to 56.1% of recurrence rates in other studies. The TAMP has advantages of surgical procedure with ease, low complications, and low recurrence rates. Therefore, after surgical excision of primary pterygium, the authors concluded the TAMP is highly recommended for good clinical outcomes and low recurrence rates.

Learning Curve for Endonasal Dacryocystorhinostomy

PURPOSE: To determine the learning curve of dacryocystorhinostomy (DCR) performed by a single oculoplastic surgeon after one year of fellowship training. METHODS: This retrospective review study comprised nasolacrimal duct obstruction patients that underwent endonasal DCR at our hospital between February 2006 and February 2008. The patients that completed at least six months of follow-up were included in the analysis. Exclusion criteria were patients less than 20 years of age and NLD obstructions due to malignancy or canalicular obstructions. Success was defined as duct patency on syringing at the final follow-up and no complaints of epiphora. RESULTS: Out of 161 eyes, the overall surgical success rate was 83.2% (134/161 eyes) and the mean postoperative follow-up period was 6.5 months (6-18 months). Success rates gradually increased as follows: 71.2% (37/52 eyes) for the first group, 88.7% (47/53 eyes) for the second group, and 89.3% (50/56 eyes) for the third group (second and third group compared to first group, p = 0.025, p = 0.017, respectively). CONCLUSIONS: To ensure high DCR success rates, the novice surgeon should perform at least 50 surgeries.

Phacovitrectomy versus Vitrectomy only for Primary Rhegmatogenous Retinal Detachment Repair

PURPOSE: To compare the outcomes of phacovitrectomy and vitrectomy only for treatment of primary rhegmatogenous retinal detachment. METHODS: The anatomical success, functional success, and complications between Group I patients who underwent vitrectomy only and Group II patients who underwent phacovitrectomy for primary rhegmatogenous retinal detachment were retrospectively compared. RESULTS: Twenty-one eyes (84.0%) in Group I had reattachment after vitrectomy only, and 27 eyes (90.0%) in Group II had reattachment after phacovitrectomy. However, the differences in the measures attributes were not statistically significant (p = 0.271). The logMAR visual acuity improved in both groups with no statistically significant difference between the two groups (p = 0.102). Postoperative complications included cataract progression in 20 eyes (80.0%) in Group I and 17 of the 20 eyes (68.0%) underwent cataract surgery within one year after the first surgery. CONCLUSIONS: Phacovitrectomy, irrespective of severe lens opacity, is a relatively effective combined surgical procedure in older patients with primary rhegmatogenous retinal detachment and impending presbyopia. The procedure allows for easy access to the periphery during vitreous shaving and prevents the need for a second cataract operation.