The Factors Influencing to the Results of Pneumatic Retinopexy

PURPOSE: To evaluate the preoperative factors influencing results of pneumatic retinopexy in patients with rhegmatogenous retinal detachment. METHODS: We analyzed retrospectively the preoperative and postoperative retinal findings, visual results, postoperative complications in 98 eyes of 98 patients who had undergone pneumatic retinopexy and followed for at least 3 months. RESULTS: Postoperatively visual acuity improved in 46 out of 59 patients whose preoperative visual acuity was equal to or less than 0.08, and in 20 out of 27 patients whose preoperative visual acuity was equal to or less than 0.5. The success rate of initial surgery was 75.5% and the final reattachment rate 99.0%. The anatomic success rate of each group did not differ in terms of the duration of retinal detachment, the size or quadrantal location of retinal break. The success rate was decreased when retinal detachment was broader or retinal breaks were multiple, although the difference was not statistically significant. The success rate was significantly lower when retinal break was located posterior to the equator than when retinal break was located on or anterior to the equator (40.0% vs 80.3%, 70.4%) (p=0.02). The main causes of failure in primary retinal reattachment were as follows: reopened retinal break in 8 eyes, new retinal break in 7 eyes, delayed absorption or shift of subretinal fluid in 5 eyes, proliferative vitreoretinopathy in 2 eyes, subretinal gas in 1 eye and endophthalmitis in 1 eye. CONCLUSIONS: Our results showed that the axial location of retinal break was the only preoperative factor influencing the success rate of pneumatic retinopexy. However, other factors may not be completely ruled out as influence factors for success rate considering the small number of patients in our study. Further study including larger series will be needed.

The Effect of Glucose Concentration on Expression of VEGF and HGF in Cultured Human RPE Cells

PURPOSE: To evaluate the expression of vascular endothelial growth factor (VEGF) and hepatocyte growth factor (HGF) in response to high glucose concentration in human retinal pigement epithelial (RPE) cells. METHODS: After confluent adult human RPE cells (ARPE-19) were cultured in RPMI 1640 media containing three different concentration of glucose (5.5, 11 and 22 mmol/L) for 3, 7 and 14 days, Western blot analysis was performed. Cell pellets were lysed in lysis buffer and cell lysates were centrifused to collect supernatant fractions for quantifying protein concentration. The proteins were subjected to electrophoresis and transferred to nitrocellulose membranes. After the blots were incubated with primary and secondary antibody to VEGF or HGF consecutively, enhanced chemiluminescence and autoradiography were performed. To evaluate the relationship between protein and mRNA expression, RNA from glucose-treated RPE cells was obtained by using RNAzolB. After cDNA was obtained through reverse transcription of RNA, PCR of cDNA was performed by using primers. RESULTS: We found that incubation with different concentrations of glucose increased the protein expression of VEGF and HGF in concentration-dependent manner in RPE. At 14 days, level of VEGF protein expression was higher in 22 mmol/L glucose group than in other two groups (5.5 mmol/L or 11 mmol/L), but no differences of mRNA expression of VEGF were observed in each group. At 3 days, level of HGF protein expression was higher in 22 mmol/L glucose group than in other groups, but mRNA expression of HGF was not detected in all groups. CONCLUSIONS: These results suggest that RPE cells may participate in angiogenesis in progression of diabetic retinopathy through production of VEGF and HGF.

A Case of Chronic Myelogenous Leukemia Involving Retina and Optic Nerve

PURPOSE: We report a case of chronic myelogenous leukemia(CML) involving the retina and optic nerve, in which visual acuity had been improved after radiation therapy combined with steroid pulse therapy. METHODS: In a 44-year-old CML patient with central nervous system involvement who presented with retinal infiltration, initial uncorrected visual acuity was 1.0 in the right eye, 0.9 in the left eye. The patient was given 1% prednisolone acetate eye drops 4 times a day and 40mg of oral prednisolone a day. One month later, papilledema and exudative retinal detachment was developed in the left eye and we raised oral prednisolone dosage to 90mg a day. In spite of those kinds of treatment, papilledema in left eye and retinal infiltration in both eyes were much more aggravated at two months. So we used high-dose steroid(solumedrol 125mg qid) parenterally for initial 3 days followed by tapered oral dosage(prednisolone 60mg/day for 11 days, tapered with 10mg/day and maintain with 10mg/day) and performed simultaneously radiation therapy (total 2340 rads, 13 times) on both eyes through 2 weeks. RESULTS: Uncorrected visual acuity was decreased to 0.3 in the left eye at one month and to 0.6 in the right eye and 0.08 in the left eye at two months, and improved to 1.0 in the right eye and 0.5 in the left eye. Gradual resolution was noted in retinal and optic disc abnormalities at one month after high-dose steroid therapy combined with radiation therapy. CONCLUSIONS: This case suggests that visual acuity in CML patient with the retinal and optic nerve involvement can be improved by using radiation therapy combined with steroid pulse therapy.