Safety of Using Matrix Metalloproteinase Inhibitor in Experimental Glaucoma Filtration Surgery

We evaluated the safety of matrix metalloproteinase (MMP) inhibitor in experimental glaucoma filtration surgery in an animal model. Fifteen New Zealand white rabbits underwent an experimental trabeculectomy and were randomly allocated into 3 groups according to the adjuvant agent: no treatment group (n = 5), 0.02% mitomycin C (MMC) soaking group (n = 5), and MMP inhibitor (ilomastat) subconjunctival injection group (n = 5). Slit lamp examination with Seidel testing, pachymetry, and specular microscopy was performed preoperatively and postoperatively. The conjunctiva and ciliary body toxicity were evaluated with scores according to the pathologic grading systems. Electron microscopy was used to examine the structural changes in cornea, conjunctiva, and ciliary body. In the ilomastat-treated group, there was no statistically significant change in central corneal thickness preoperatively and at 28 days postoperatively (P = 0.655). There were also no significant changes in specular microscopy findings over the duration of the study in the ilomastat-treated group. The conjunctival toxicity score was 1 in the control group, 1.5 in the ilomastat-treated group, and 2 in the MMC-treated group. When assessing ciliary body toxicity scores, the ilomastat-treated group score was 0.5 and the MMC-treated group score was 1.5. Transmission electron microscopy did not show structural changes in the cornea and ciliary body whereas the structural changes were noticed in MMC group. A single subconjunctival injection of MMP inhibitor during the experimental trabeculectomy showed a less toxic affect in the rabbit cornea, conjunctiva, and ciliary body compared to MMC.

Photodynamic Therapy of Choroidal Neovascularization in Age-Related Macular Degeneration with Verteporfin: An Analysis of 10 Years of Clinical Results

PURPOSE: To analyze the long-term results of photodynamic therapy (PDT) for exudative age-related macular degeneration (AMD). METHODS: The clinical data of patients treated with photodynamic therapy for exudative age-related macular degeneration between April 2000 and December 2000 were analyzed. Patients were followed-up for at least 10 years after PDT. RESULTS: Twenty-nine eyes of 29 patients were enrolled. Mean visual acuity on the logarithm of the minimum angle of resolution (log MAR) scale was 0.78 +/- 0.34 at baseline, 1.01 +/- 0.42 at 60 months, and 1.02 +/- 0.41 at 120 months. Predominantly classic, minimally classic, and occult without classic choroidal neovascularization was noted in 51.7%, 17.2%, and 31.1% of patients, respectively. Visual acuity was improved by 1 or more lines in 27.6% of patients and was unchanged in 20.7% of patients, while 51.7% of patients had lost 1 or more lines of visual acuity by 120 months. Baseline visual acuity and age were associated with the final visual prognosis (p < 0.05). Four patients developed neovascular AMD in the contralateral eye. CONCLUSIONS: PDT is safe and effective for neovascular AMD. However, AMD can recur at any time and thus patients should be followed-up for a long period of time.

Comparison of Choroidal Thickness in Eyes with Central Serous Chorioretinopathy, Asymptomatic Fellow Eyes and Normal Eyes

PURPOSE: To compare the choroidal thickness in central serous chorioretiopathy (CSC) patients and normal controls using spectral domain optical coherence tomography (SD-OCT). METHODS: The authors compared the choroidal thickness in eyes with CSC, fellow eyes and in normal eyes. In addition, the authors attempted to determine any correlation between choroidal thickness and other factors such as age, height of serous retinal detachment, and spherical equivalent. Choroidal thickness was measured using a perpendicular line from the outer margin of the subfoveal retinal pigment epithelium to the inner surface of the sclera. RESULTS: Twenty-five eyes of 25 CSC patients, 17 fellow eyes and 29 age-matched normal eyes were examined and categorized as group 1, group 2 and group 3, respectively. Subfoveal choroidal thickness was 370.64 +/- 58.06 microm in group 1, 301.85 +/- 47.83 microm in group 2, and 261.84 +/- 48.22 microm in group 3. The choroidal thickness in group 1 was significantly greater than those in group 2 and group 3, and the choroidal thickness in group 2 was significantly greater than that in group 3 (p = 0.001, p < 0.001, p = 0.004, respectively), where the choroidal thickness showed a negative correlation with age (p = 0.015). CONCLUSIONS: The choroidal thickness was greater in eyes with CSC and in their fellow eyes compared to that in normal eyes. The results suggest that CSC may be caused by choroidal vascular hyperpermeability and increased hydrostatic pressure in the choroid.

Effectiveness of Preoperative Intravitreal Bevacizumab Injections in Pars Plana Vitrectomy for Proliferative Diabetic Retinopathy

PURPOSE: To evaluate the efficacy of preoperative intravitreal bevacizumab (Avastin(R); Genetech, San Francisco, CA, USA) injections of pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR). METHODS: Thirty patients (30 eyes) who underwent PPV for treatment of PDR and received a preoperative intravitreal bevacizumab injection of 1.25 mg were retrospectively analyzed. The study group (group 1, 30 patients, 30 eyes) was compared with a control group (group 2, 29 patients, 30 eyes and matched with the study group for preoperative parameters) who underwent PPV without preoperative intravitreal bevacizumab injection. RESULTS: In both groups, visual acuity improved but there was no statistical significance. Intraoperative vitreous hemorrhage occurred in 14 eyes (46.7%) from group 1 and 11 eyes (36.7%) from group 2. There was no statistical significance of intraoperative bleeding occurrence (p=0.3). Postoperative vitreous hemorrhage occurred in 4 eyes from group 1 and 14 eyes from group 2. The group 1 had a lower incidence of postoperative hemorrhage than group 2 (p=0.005). CONCLUSIONS: Preoperative intravitreal bevacizumab injection appears effective in decreasing early postoperative vitreous hemorrhage and maybe technically helpful in PPV for PDR.

Effectiveness of Preoperative Intravitreal Bevacizumab Injections in Pars Plana Vitrectomy for Proliferative Diabetic Retinopathy

PURPOSE: To evaluate the efficacy of preoperative intravitreal bevacizumab (Avastin(R); Genetech, San Francisco, CA, USA) injections of pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR). METHODS: Thirty patients (30 eyes) who underwent PPV for treatment of PDR and received a preoperative intravitreal bevacizumab injection of 1.25 mg were retrospectively analyzed. The study group (group 1, 30 patients, 30 eyes) was compared with a control group (group 2, 29 patients, 30 eyes and matched with the study group for preoperative parameters) who underwent PPV without preoperative intravitreal bevacizumab injection. RESULTS: In both groups, visual acuity improved but there was no statistical significance. Intraoperative vitreous hemorrhage occurred in 14 eyes (46.7%) from group 1 and 11 eyes (36.7%) from group 2. There was no statistical significance of intraoperative bleeding occurrence (p=0.3). Postoperative vitreous hemorrhage occurred in 4 eyes from group 1 and 14 eyes from group 2. The group 1 had a lower incidence of postoperative hemorrhage than group 2 (p=0.005). CONCLUSIONS: Preoperative intravitreal bevacizumab injection appears effective in decreasing early postoperative vitreous hemorrhage and maybe technically helpful in PPV for PDR.

The Clinical Evaluation of Ocular Complications from Electrical Burn Injury

PURPOSE: This current study determined the type, incidence, characteristics of ocular complications from electrical burn and associated risk factors. METHODS: The authors retrospectively reviewed ocular complications from electrical injury on ninety-seven consecutive electrical burn patients. RESULTS: Of the ninety-seven patients with electrical burns, twelve patients (12%) had ocular complications (cataract, uveitis, macular hole, corneal opacity, and optic atrophy). The relationship between voltage and development of ocular complication was not statistically significant. The relationship between wound size and development of ocular complication was not significant. However, the relationship between entry site and development of ocular complication was statistically significant (P=0.00). CONCLUSIONS: The patient who had electrical injury at any voltage with any wound size, especially electrical head injury for at least 6 months should be evaluated carefully.

Spontaneous Regression of Neovascularization at the Disc in Diabetic Retinopathy

Neovascularization at the disc (NVD) is the most serious complication in diabetic retinopathy, and leads to vitreous hemorrhage and tractional retinal detachment. We report two cases of spontaneous regression of NVD in proliferative diabetic retinopathy. Two men (31 and 46 years old) with diabetes had NVD in both eyes. They were treated with panretinal photocoagulation on the left eye first, but their right eyes went untreated, because they did not revisit our clinic for several months. Fortunately, on revisit, their neovascularization had disappeared a few months later in both eyes, including their untreated right eyes. We could not find any specific causes for the spontaneous regression of the new vessels.

A Case of Ebstein's Anomaly Combined with Patent Foramen Ovale

Ebsteins anomaly is characterized by a downward displacement of the tricuspid valve into the right ventricle. Its anatomical abnormality is displacement of septal and posterior leaflets of tricuspid valve from atrioventricular ring into the body of right ventricle and therefore a portion of right ventricle is atrialized. The primary hemodynamic anomaly producing symptoms in Ebsteins malformation is tricuspid regurgitation. Its natural history and clinical features depend on the drgree of displacement of tricuspid leaflets from atrioventricular ring. Although most patients with Ebsteins anomaly are diagnosed in early children, some patients with a mildly deformed tricuspid valve may remain asympto- matic well into adulthood. Most common complaints adult-onset disease are exertional dyspnea, fatigue, palpitation and cyanosis. In rnost cases the physical exarnination, electrocardiogram, and roentgenogram are sufficiently to allow the diagnosis. But, recently echocardiography has played an important role in the recognition of Ebsteins anomaly because two-dimensional echocardiography provides direct visualization of the abnormally displaced tricuspid valve apparatus. So echocardiography has replaced angiography as the procedure of choice for diagnostic and morphologic assessrnent of patients with Ebsteins anomaly. We experienced a 67-year-old female patient with Ebstein's anomaly that was definitely diagnosed by two-dimentional echocardiography. We report this case with literature review.

Reversal of Dilated Cardiomyopathy with medical therapy in a case of Pheochromocytoma

Dilated cardiomyopathy secondary to pheochromocytoma is rare but has been reported to be partially or completely reversible in some cases. A woman with hypertension and cardiac failure due to pheochromocytoma was found to have a dilated, hypokeinetic left ventricle and a restrictive left ventricular filling pattern on two-Dimensional and Doppler echocardiograms. Left ventricular cavity was normalized after aggressive drug treatment, and after sugery of pheochromocytoma,left ventricular filling pattern and blood pressure as well as left ventricular function in echocardiogram were also completely normalized on follow-up without any drug.

Reversal of Dilated Cardiomyopathy with medical therapy in a case of Pheochromocytoma

Dilated cardiomyopathy secondary to pheochromocytoma is rare but has been reported to be partially or completely reversible in some cases. A woman with hypertension and cardiac failure due to pheochromocytoma was found to have a dilated, hypokeinetic left ventricle and a restrictive left ventricular filling pattern on two-Dimensional and Doppler echocardiograms. Left ventricular cavity was normalized after aggressive drug treatment, and after sugery of pheochromocytoma,left ventricular filling pattern and blood pressure as well as left ventricular function in echocardiogram were also completely normalized on follow-up without any drug.

A Successful Endoscopic Injection Sclerotherapy of a Bleeding Duodenal Varix / 대한소화기내시경학회지

Bleeding frorn the duodenal varix is an unusual event. Upper gastrointestinal endoscopy is the diagnostic procedure of choice in diagnosing duodenal varices. If performed during active bleeding, it can differentiate between esophageal and duodenal varices as the source, which has important therapeutic implications. A thorough examination of the duodenum for varices is important in an upper gastrointestinal hemorrhage. Treatment modalites for bleeding duodenal varices are sclerotherapy, varix suture ligation, portocaval shunt, and duodenal resection. Although endoscopic sclerotherapy has lirnited success in controlling active duodenal varix as initial treatment, endoscopic injection sclerotherapy is a useful first-line therapeutic measure in the treatment of bleeding duodenal varices. In this study we present a case of a ruptured duodenal varix, which was defected by an endoscopy, in a 61-year-old male. An endoscopic examination showed small and nonbleeding esophageal varices and a prominant ulcerated varix was identified in the 2nd portion of the duodenum. Endoscopic sclerotherapy was performed by injecting ethanolamine oleate into the varix. Our report demonstrate that endoscopic sclerotherapy can be efficient even in the presence of acute bleeding and that it can provide a definitive method of curing of a bleeding duodenal varix.

A Case of Systemic Lupus Erythematous (SLE) with Graves' Desease and Idiopathic Thrombocytopenic Purpura (ITP) / 대한내분비학회지

Autoimmune diseases are occasionally associated with other autoimmune diseases in the same patients. Autoimmune Graves' disease has been associated with systemic rheumatic diseases including systemic lupus erythematosus (SLE). And Graves' disease associated with idiopathic thrornbocytopenic purpura (ITP) has been reported many times in Korea. There is a special relationship between SLE and ITP, both of which are autoimmune diseases. Some patients with thrombocytopenic purpura, labeled as idiopathic at the onset, later develop a classical course of SLE, suggesting that ITP may be an early manifestation of SLE. The relationships among these three conditions and their pathogenesis are poorly undemtood, and the coexistence of these diseases at the same time has been reported very rarely, but it may be very probable that there are some relationships among them. We report a case of SLE associated with Graves' disease and ITP treated well by imunosup-pressive agent who had been suffering from recurrence by conventional treatments (antithyroid medication, corticosteroid, subtotal thyroidectomy and splenectomy).