Change in Angle Parameters Measured by Anterior Segment Optical Coherence Tomography after Laser Peripheral Iridotomy Alone versus Laser Peripheral Iridotomy and Argon Laser Peripheral Iridoplasty

PURPOSE: To compare the changes in angle parameters after laser peripheral iridotomy (LPI) alone versus LPI and ALPI (argon laser peripheral iridoplasty) in primary angle closure patients by using anterior segment optical coherence tomography (AS-OCT). METHODS: A total of 25 eyes from 17 patients with narrow angles were enrolled in this present study. Eleven eyes in the LPI treatment group and 14 eyes in the LPI and ALPI combined treatment group were evaluated using AS-OCT. The anterior chamber depth (ACD), angle opening distance at 500 microm (AOD 500) and 750 microm (AOD 750), angle recess area at 500 microm (ARA 500) and 750 microm (ARA 750), trabecular-iris space area at 500 microm (TISA 500) and 750 microm (TISA 750), trabecular-iris angle (TIA) were measured. The pre- and post-treatment parameters were compared in each group. The parameter changes after laser treatment were also compared. RESULTS: AOD 500, AOD 750, ARA 500, ARA 750, TISA 500 and TISA 750 except ACD significantly increased following LPI treatment (p = 0.013, p = 0.010, p = 0.008, p = 0.003, p = 0.006, p = 0.003, p = 0.013, respectively, Wilcoxon signed rank test) and LPI and ALPI combined therapy (p = 0.001, p = 0.001, p = 0.001, p = 0.001, p = 0.001, p = 0.001, p = 0.001, respectively, Wilcoxon signed rank test). The AOD 500 difference, TISA 500 difference, and TISA 750 difference were significantly greater after LPI and ALPI combined therapy than after LPI treatment alone (p = 0.112, p = 0.147, p = 0.049, p = 0.037, respectively, Mann-Whitney U-test). CONCLUSIONS: The results from the present study showed LPI alone or LPI and ALPI combined therapy significantly widened the anterior chamber angle and combined therapy showed greater effect than LPI alone.

The Measurement of Flow Resistance in Drainage Implants Using Various Tube Ligation Methods

PURPOSE: To evaluate the flow resistance though the tube in a glaucoma drainage implant using various tube ligation methods. METHODS: To measure the flow resistance, the following tube ligation methods were designed and tested: Type 1: no ligation of Ahmed valve tube. Type 2: ligation of Ahmed valve tube with 8-0 Vicryl. Type 3: ligation of Molteno tube and a 6-0 Vicryl as an intra-luminal stent with 8-0 Vicryl. Type 4: ligation of Ahmed valve tube and three strands of 8-0 nylon as extra-luminal stents with 8-0 Vicryl. Type 5: ligation of Ahmed valve tube and a 6-0 Prolene as an extra-luminal stent with 8-0 Vicryl followed by removal of the Prolene for partial ligation. RESULTS: The pressure was maintained under 0.143 mm Hg in type 1. In type 2, the pressure increased to 6.688 mm Hg and dropped to approximately 6.384 mm Hg. In type 3, the pressure was maintained at 5.396 mm Hg which decreased to 3.572 mm Hg after stent removal. In type 4, the pressure was maintained at 5.700 mm Hg which dropped to 5.472 mm Hg after the 1st stent removal, to 5.016 mm Hg after the 2nd stent removal and to 4.180 mm Hg after the 3rd stent removal. In type 5, the pressure increased to 6.384 mm Hg and decreased to 5.624 mm Hg. CONCLUSIONS: The tube ligation along with extra-luminal stents followed by staged removal may provide prevention of hypotony and staged control of intraocular pressure after a glaucoma implant operation.

Hemodynamic Changes after Endotracheal Intubation in Patients with Cerebral Aneurysm

BACKGROUND: Tracheal intubation with a lightwand intubating device (Trachlight) attenuates the hemodynamic stress response to tracheal intubation compared with a direct laryngoscope approach. We compared the effects of the direct laryngoscope (Macintosh blade) and lightwand for intubation in patients with cerebral aneurysm. METHODS: Twenty-four patients undergoing cerebral aneurysm clipping surgery were randomly divided to either the lightwand (Group 1, n = 12) or the laryngoscope (Group 2, n = 12) Group. All patients received fentanyl (2-3microg/kg), midazolam (0.1 mg/kg), and thiopental sodium (2-3microg/kg) followed by vecuronium (0.1- 0.15microg/kg). The lungs were ventilated with 3-4% isoflurane in oxygen, with 1% lidocaine (1-1.5microg/kg) administered before intubation with either the lightwand or the laryngoscope. Systolic, diastolic and mean blood pressures and heart rate were recorded continuously before and for 5 min after intubation. RESULTS: Systolic and mean arterial blood pressure increased significantly (P < 0.05) 1 minute after intubation, but then returned to normal within the next minute. There were no differences in hemodynamic changes between the two groups, and no complications. CONCLUSIONS: Intubation technique did not affect hemodynamic changes in patients with cerebral aneurysm. In patients with aneurysms, appropriate anesthetic levels and pharmacologic manipulation will attenuate the hemodynamic stress response associated with tracheal intubation.

Comparison of the Clinical Diagnosis of Diabetic Macular Edema with Diagnosis by Retinal Thickness Analyzer

PURPOSE: To evaluate the correlation between diabetic macular edema diagnosed with stereoscopic slit-lamp and retinal thickness analyzer (RTA). METHODS: Diabetic macular edema diagnosed with stereoscopic slit-lamp was compared to indices of RTA in 50 eyes of 32 persons which were diagnosed clinically with diabetic retinopathy. RESULTS: From stereoscopic slit-lamp results, diabetic macular edema was present in 39 of 50 eyes, and absent in 11 of 50. Foveal average thickness out of the RTA indices was 209.7+/-58.5 micrometer from observing diabetic macular edema clinically and 199.4+/-47.3 micrometer from not observing diabetic macular edema clinically. Statistically significant differences were found in average foveal thickness between the 2 groups (p=0.013). CONCLUSIONS: RTA appears to serve as a useful and sensitive tool for the diagnosis of diabetic macular edema.

Impression Cytology of Herpetic Simplex Keratitis in Rabbits

PURPOSE: To use impression cytology to examine the structural changes in corneal epithelial cells infected with the herpes simplex virus in rabbit eyes. METHODS: Corneal surfaces of 7 rabbits were scratched using a 25-gauge needle. Herpes simplex virus (type 1, Kos strain) was inoculated to the injured cornea. As the corneal diseases were observed using slit lamp biomicroscopy, impression cytology was performed for 18 days after inoculation. Specimens were stained with hematoxylin-eosin and examined using optical microscopy. RESULTS: Corneal lesions consisted mainly of round epithelial cells, inflammatory cells, ballooning cells, multinucleated giant cells, and various inclusion bodies. Over time, the corneal epithelial cells peeled away as a result of corneal edema in the corneal lesions. Dendritic lesions were also observed. In the recovery phase, the number of detached cells and infiltrated inflammatory cells decreased. CONCLUSIONS: It was presumed that dendritic lesions might have been formed at the scratched cornea region, thereby aggravating the epithelial cells falling off as a result of the infiltration of inflammatory cells. These cytopathologic effects occur in experimental herpes simplex keratitis.

Accuracy of Optic Disc Parameters Obtained by the Heidelberg Retina Tomograph in the Diagnosis of Glaucoma

PURPOSE: To determine which optic disc topographic parameters, obtained by the Heidelberg Retina Tomograph (HRT), are most useful to distinguish normal eyes from those with early to moderate glaucomatous visual field defects. METHODS: From each of 92 normal subjects and 154 patients with primary open-angle glaucoma one randomly selected eye was studied. The Humphrey perimeter, program C 30-2 visual fields, and 13 HRT parameters (software 2.01, includes rim to disc area ratio) were utilized. Because some of the optic disc parameters depend on the optic disc area, these parameters were corrected for the effect of disc area. The total glaucoma group was divided into three subgroups according to the visual field defects: early (mean deviation [MD] >-6 dB, 65 eyes), moderate (MD -6 to -12 dB, 49 eyes), and severe (MD <-12 dB, 40 eyes) glaucoma groups. RESULTS: In eyes with early glaucoma (MD = -3.43 +/- 1.60 dB), the sensitivity, specificity, accuracy, and areas under the receiver operating characteristic curve were, respectively: rim area (69%, 71%, 70%, 0.802), rim to disc area ratio (69%, 72%, 71%, 0.799), cup area (72%, 70%, 71%, 0.789) and cup to disc area ratio (69%, 70%, 69%, 0.790). In eyes with moderate glaucoma (MD = -8.75 +/- 1.88 dB), they were, respectively: rim area (78%, 86%, 83%, 0.872), rim to disc area ratio (76%, 86%, 82%, 0.869), cup area (76%, 87%, 83%, 0.864) and cup to disc area ratio (78%, 84%, 82%, 0.862). There was considerable overlap in HRT parameters between the normal and early glaucoma groups. CONCLUSIONS: The diagnostic value of single optic disc parameter had its limitations in the diagnosis of early stage glaucoma.

The Influence of Age, Gender, Refractive Error, and Optic Disc Area on the HRT Parameters in Normal Eyes

PURPOSE: To study the influence of age, gender, refractive error, and optic disc size on the optic disc parameters measured with the Heidelberg Retina Tomograph (HRT; software 2.01) in normal eyes. METHODS: Ninety-two normal subjects (mean refractive error +/- SD: -0.15 +/- 1.64 D, range -6.63 to +3.38 D) were examined using HRT. The influence of age, refraction, and disc area on each parameter was analysed by multiple linear regression. RESULTS: Large discs had large values of cup area, cup volume, rim area, cup to disc area ratio, and mean cup depth. Large discs had small values of rim to disc area ratio. However, rim volume, maximum cup depth, cup shape measure, height variation contour, mean retinal nerve fiber layer thickness, and retinal nerve fiber layer cross-sectional area were not related to disc area. Most parameters were independent of age or refractive error except for a few parameters. Age was weakly related to disc area. Refractive error was weakly associated with cup shape measure. Gender had no statistically significant influence on optic disc parameters. CONCLUSIONS: These results indicate that several optic disc parameters have better correlations with the optic disc area than age, gender, and refractive error. These differences must be considered in the evaluation of optic disc for glaucoma.

Interobserver Reliability between MRI, CT-myelogram and Myelogram in the Evaluation of Lumbar Spinal Stenosis / 대한정형외과학회잡지

PURPOSE: We designed this study to evaluate the interobserver reliability of magnetic resonance imaging (MRI), post-myelographic computed tomography (CT-myelogram) and myelography for the diagnosis of lumbar spinal stenosis. MATERIALS AND METHODS: Thirty two patients with lumbar spinal stenosis were evaluated preoperatively by MRI, CT-myelography, and myelography by four observers. For each set of scans, the examiners assessed the presence or absence of; 1) intervertebral disk protrusion, 2) facet arthrosis, 3) ligamentum flavum hypertrophy, and 4) nerve root impingement. The severities of 1) central, 2) lateral, 3) foraminal and 4) entire spinal stenosis were graded using a four-point scale range from 1 (no stenosis) to 4 (severe stenosis). RESULTS: Kappa statistical analysis revealed moderate interobserver agreement in terms of disk protrusion (0.49), nerve root impingement (0.42) and lateral stenosis grade based on MRI. Low levels of agreement were found for facet arthrosis and ligamentum flavum hypertrophy. Relatively higher levels of agreement were found for nerve root impingement, lateral stenosis and entire stenosis, graded by MRI and for central stenosis graded by myelography. CONCLUSION: The results of this study reflect that MRI showed relatively higher levels of interobserver reliability than the other diagnostic modalities in the evaluation of patients with lumbar spinal stenosis.

Histological Characteristics of the Interface of Corneal Stroma and Descemet's Membrane

PURPOSE: This study was carried out to clarify the histological characteristics of the interface of the corneal stroma and Descemet's membrane of the human eye. METHODS: Nighteen donor eyes without corneal pathology were examined by scanning and transmission electron microscopy. The Descemet's membrane including the corneal endothelium was cheked for scanning electron microscopy. The junctional characteristics of the posterior corneal stroma and Descemet's membrane was examined by transmission electron microscopy. RESULTS: The scanning electron microscopy showed that collagen sheet faced each other at the right angle near the Descemet's membrane and penetrated the Descemet's membrane with the irregular arrangement. The transmission electron microscopy showed that the electron-dense collagen filaments extended to the posterior stroma from Descemet's membrane. The arrangement of electron-dense collagen filaments paralleled with the arrangement of the collagen fibrils of the posterior stroma. CONCLUSIONS: The interface of the corneal stroma and Descemet's membrane was composed of two-typed extracellular materials without the intercellular specificatons.

Anti-IL-4 antibody inhibits antigen specific IgE response but fails to prevent chicken gamma globulin-induced active systemic anaphylaxis: evidence for the involvement of IgG antibodies

It has recently been reported that interleukin-4 (IL-4) is required for the production of IgE, and anti-IL-4 monoclonal antibody (mAb) inhibits in vivo IgE responses. These suggest that blocking of IL-4 activity may be useful for the prevention or treatment of immediate hypersensitivity disorders. In this study we investigated whether anti-IL-4 has a regulatory role in chicken-gamma globulin (CGG)-induced active systemic anaphylaxis. Multiple injections of anti-IL-4 (up to 40 mg/mouse) failed to protect the mice from fatal anaphylaxis. Anti-IL-4 strongly suppressed CGG-specific IgE response (>90%) without any suppressive effect on CGG-specific IgG (IgG1, IgG2a, IgG2b, and IgG3) responses. Because these data suggest the possibility that fatal anaphylaxis could be induced by IgG antibodies, we examined the possibility using anti-CGG polyclonal and the subclasses of IgG monoclonal antibodies. Passive sensitization of mice with polyclonal antibodies elicited severe and fatal anaphylactic shock; about 50% of the mice died. The activity of antibodies was not diminished by heat treatment (56 degrees C, 2h), suggesting that the anaphylaxis was not mediated by IgE. Shock was also elicited by each subclass of IgG mAb; of these, IgG1 was the most effective. Combination of the IgG subclasses elicited more exaggerated shock; about 30% of mice died. These data indicate that IgG antibodies are themselves sufficient to induce systemic anaphylaxis. Therefore, the failure of anti-IL-4 to prevent active anaphylaxis is probably due to the inability of anti-IL-4 to suppress the production of IgG antibodies.

Effects of monoclonal anti-IL-4 antibody(11B11) and interferons on IgE production in vivo and hypersensitivity reactions II. suppressive effects of a PAF antagonist, BN 50739 on active systemic anaphylaxis in sensitized mice / 대한면역학회지

No abstract available.