Comparative Analysis of the Tear Protein Expression After Photorefractive Keratectomy Using Two-Dimensional Electrophoresis

PURPOSE:To investigate the change in the tear protein composition of patients who underwent refractive surgery. METHODS: Tear samples were collected before photorefrative keratectomy (PRK), on the first, the second, and the third postoperative day, and then a month after the operation from 40 eyes of 20 patients. These tear samples were analyzed using two-dimensional gel electrophoresis (2-DE). Matrix-associated laser desorption/ionization time of flight (MALDI-TOF) was employed for the identification of expressed proteins. Control tear samples were collected from 40 eyes of 20 healthy volunteers who had no history of ocular surgery or pathology. RESULTS: On the first postoperative day, lipocalin-1 precursor, lipocalin-1, and lysozyme were up-regulated. On the second postoperative day, serum albumin precursor and serum albumin were up-regulated. The tears collected on the third postoperative day and after 1 month had similar protein expression levels to the control group. Lipocalin 1 precursor and lysozyme were up-regulated and down-regulated after reftactive surgery, respectively. However, each protein had a different molecular weight and isopotential point. CONCLUSIONS: The tear protein composition changed uniquely in the early postoperative period, and proteins with different isopotential points were detected after PRK. We hypothesized that the healing process might influence the expression of the tear proteins.

Changes in Refraction and Anterior Chamber Depth According to the Type of the Intraocular Lenses

PURPOSE: To evaluate the changes of refraction and anterior chamber depth in pseudophakia with the single-piece intraocular lenses (IOLs) and the three-piece IOLs after cataract surgery. METHODS: This single-center prospective study comprised of 34 eyes in 27 cataract patients who underwent cataract surgery. Eighteen eyes of seventeen patients received the single-piece IOLs, and sixteen eyes of fifteen patients received the three-piece IOLs. At one day, one week, and six months after cataract surgery, the refraction, corneal thickness, and anterior chamber depth of both groups were measured and analyzed. RESULTS: The refraction after cataract surgery was not significantly different from the preoperative predictive refraction in both IOL groups. The corneal thickness increased significantly as compared with preoperative value at operative day in both groups. However, after 1 week postoperatively, there was no statistically significant difference between the preoperative and the postoperative corneal thickness. The anterior chamber depth of the single-piece IOL group decreased constantly, and the decrease was statistically significant at 6 months postoperatively. In the three-piece group the anterior chamber depth was stationary and there was no statistically significant change from 1 day postoperatively. CONCLUSIONS: There was remarkable difference of the changes of anterior chamber depth after cataract surgery between the single-piece and the three-piece IOL groups. In particular, the relative decrease of anterior chamber depth of the single-piece IOL group would affect the postoperative refractive errors.

The Risk Factors for Severe Thyroid-Associated Orbitopathy

PURPOSE: To determine risk factors for severe Thyroid-Associated Orbitopathy (TAO). METHODS: We retrospectively studied the clinical data of 385 patients of the New York City area diagnosed with TAO from January 1990 to December 2000. We reviewed clinical characteristics and tried to identify several risk factors. The statistical analysis was applied to the collected data. RESULTS: Men more frequently had proptosis, restrictive myopathy, and optic neuropathy than women. Patients older than 50 years presented more frequently with proptosis, restrictive myopathy, and optic neuropathy than younger than 50 years. Patients with a family history of thyroid disease had similar clinical characteristics compare to those without family history. Smokers more often had proptosis, restrictive myopathy, and compressive optic neuropathy than nonsmokers. Patients who had received radioactive iodine (RAI) treatment were older, and were more frequently smokers. If patients were smokers and treated with radioactive iodine treatment, they were more likely to have proptosis, restrictive myopathy, and compressive optic neuropathy than if not treated with radioactive iodine. However, the RAI treatment did not seem to be associated with severe characteristics of TAO in non-smokers. CONCLUSIONS: The risk factors for severe TAO are: male, age older than 50, smoking, treated with RAI in smokers.

Cases of Complications after the Use of Punctal Plugs

PURPOSE: To report cases of complications after using punctual plugs with a literature review. METHODS: We studied 3 complicated cases after the use of punctual plugs: a 46-year-old female with recurrent mucopurulent discharge, a 42-year-old male with a pinkish mass over the punctum, and a 29-year-old female with recurrent epiphora. RESULTS: The 46-year-old female was diagnosed with canaliculitis caused by actinomyces, the 42-year-old male with chronic pyogenic granuloma, and the 29-year-old female with canalicular obstruction. All 3 cases improved after proper treatments. CONCLUSIONS: Complications after the use of punctal plugs are not common but they can be significant. They have to be used carefully after through evaluation and obtained proper informed consents from the patient.